title: Scope and nature of sudden cardiac death before age 40 in Ontario: a report from the cardiac death advisory committee of the office of the chief coroner.
abstract: BACKGROUND
  Understanding sudden cardiac death in the young may inform prevention strategies.
  
  
  OBJECTIVE
  To determine the scope and nature of sudden death in a geographically defined population.
  
  
  METHODS
  We performed a retrospective population-based cohort study in Ontario, Canada, of all sudden cardiac death cases involving persons aged 2-40 years identified from the 2008 comprehensive Coroner database. Of 1741 Coroner's cases, 376 were considered potential sudden cardiac death cases and underwent review.
  
  
  RESULTS
  There were 174 cases of adjudicated sudden cardiac death from a population of 6,602,680 persons aged 2-40 years. Structural heart disease was present in 126 cases (72%), 78% of which was unrecognized. There was no identifiable cause of death in 48 cases (28%), representing primary arrhythmia syndromes. The majority of decedents were men (76%) over the age of 18 (90%). The overall incidence of sudden cardiac death increased with age from 0.7/100,000 (2-18 years) to 2.4/100,000 (19-29 years) to 5.3/100,000 (30-40 years) person-years. Persons experiencing sudden cardiac death before age 30 were more likely to have a primary arrhythmia syndrome (odds ratio 2.97; P<.001). The majority of events occurred in the home (72%); 33% of the events in children/adolescents and 9% of the events in adults occurred during reported moderate or vigorous exercise (P = .002). There were no pediatric deaths during organized competitive sports.
  
  
  CONCLUSIONS
  The incidence of sudden cardiac death increases with age, typically occurring in a man at rest in the home with unrecognized underlying heart disease or a primary arrhythmia syndrome. Prevention strategies should consider targeting identification of unrecognized structural heart disease and primary arrhythmia syndromes.
authors.affiliation: Department of Medicine, University of Western Ontario, London, Ontario, Canada.
authors.forename: Caileigh M
authors.initials: CM
authors.lastname: Pilmer
authors.forename: Bonita
authors.initials: B
authors.lastname: Porter
authors.forename: Joel A
authors.initials: JA
authors.lastname: Kirsh
authors.forename: Audrey L
authors.initials: AL
authors.lastname: Hicks
authors.forename: Norman
authors.initials: N
authors.lastname: Gledhill
authors.forename: Veronica
authors.initials: V
authors.lastname: Jamnik
authors.forename: Brent E
authors.initials: BE
authors.lastname: Faught
authors.forename: Doris
authors.initials: D
authors.lastname: Hildebrandt
authors.forename: Neil
authors.initials: N
authors.lastname: McCartney
authors.forename: Robert M
authors.initials: RM
authors.lastname: Gow
authors.forename: Jack
authors.initials: J
authors.lastname: Goodman
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
mesh_terms: D000293:Adolescent; D000328:Adult; D026683:Advisory Committees; D017677:Age Distribution; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D003334:Coroners and Medical Examiners; D016208:Databases, Factual; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D055815:Young Adult