title: Incidence of sudden cardiac death in Germany: results from an emergency medical service registry in Lower Saxony.
abstract: OBJECTIVE
  Sudden cardiac death (SCD) is among the most common causes of death in western countries including Germany. Whereas risk stratification and primary prevention is still insufficient, we also lack accurate incidence estimates. Current estimates vary widely (18.6-128/100,000/year), but data on SCD incidence in Germany are missing. Depending on SCD definitions, death needs to occur between 1 and 24 h after the onset of symptoms.
  
  
  RESULTS
  In the district of Aurich (190,000 inhabitants, Lower Saxony, Germany), emergency medical service (EMS) is provided by a district government operated single carrier and two hospitals. To evaluate all EMS calls in this district from 2002 to 2009, we obtained EMS protocols, medical records, and death certificates for data analysis and adjudication of SCD. We defined SCD according to the definition of the World Health Organization, considering patients with cardiac arrest within ≤1 h after the onset of symptoms. We also required cardiopulmonary resuscitation being performed by EMS personnel. The overall mortality rate in the district of Aurich (1060/100,000/year) corresponded well with the average mortality rate in Germany (1030/100,000/year). During the observation period, we adjudicated 1212 SCD cases, equivalent to an annual rate of 151 SCD cases (81 cases/100,000/year). Rates remained remarkably stable over time, and affected a considerable number of individuals of working age (32/100,000/year).
  
  
  CONCLUSIONS
  Consistent with prior reports, the SCD incidence in a district of Germany is substantial. Despite an elaborate EMS system and advanced medical care, SCD rates remain stable and necessitate improved, individualized risk stratification.
authors: Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University Munich, 80336 Munich, Germany Department of Medicine, Kliniken an der Paar, 86551 Aichach/Friedberg, Germany.
authors: Eimo
authors: E
authors: Martens
authors: Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University Munich, 80336 Munich, Germany.
authors: Moritz F
authors: MF
authors: Sinner
authors: Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University Munich, 80336 Munich, Germany.
authors: Johannes
authors: J
authors: Siebermair
authors: Department of Anaesthesiology, Ubbo-Emmius-Hospital Ostfriesland, 26506 Norden, Germany.
authors: Carsten
authors: C
authors: Raufhake
authors: Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University Munich, 80336 Munich, Germany.
authors: Britt M
authors: BM
authors: Beckmann
authors: Emergency Medical Service Aurich, 26605 Aurich, Germany.
authors: Stefan
authors: S
authors: Veith
authors: Emergency Medical Service Aurich, 26605 Aurich, Germany.
authors: Dieter
authors: D
authors: Düvel
authors: Center of Cardiology at Hospital of Starnberg, 82319 Starnberg, Germany.
authors: Gerhard
authors: G
authors: Steinbeck
authors: Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University Munich, 80336 Munich, Germany Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (DZHK), partner site Munich Heart Alliance, 80802 Munich, Germany skaab@med.lmu.de.
authors: Stefan
authors: S
authors: Kääb
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000401:mortality* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D055815:Young Adult
keywords: Cardiac arrest; Emergency medical service; Epidemiology; Germany; Resuscitation; Sudden cardiac death