Low rate of secondary prevention ICDs in the general population: multiple-year multiple-source surveillance of sudden cardiac death in the oregon sudden unexpected death study
Journal of Cardiovascular Electrophysiology, 07/16/2012
HAVMOELLER R et al. – Authros report annualized sudden cardiac death (SCD) incidence from a multiple–year, multiple–source community–based study, with higher than expected rates of women and subjects age ≤55 yrs. The low implantation rate of secondary prevention ICDs is likely to be multifactorial, but there are potential implications for re–calibration of the projected need for ICD implantation; larger and more detailed studies are warranted.Methods
- From the on–going Oregon Sudden Unexpected Death Study, authors analyzed prospectively identified SCD cases in Multnomah County, Ore, (population =700,000) from February 1, 2002 to January 31, 2005.
- Detailed information ascertained from multiple sources (first responders, clinical records and medical examiner) was analyzed.
- A total of 1,175 SCD cases were identified (61% male) with a mean age of 65±18 yrs for men vs. 70±20 for women (P <0.001).
- The overall incidence rate for the period was 58/100,000 residents/year.
- One–quarter (24.6%) were ≤55 yrs of age.
- The most common initial rhythm was ventricular tachycardia or fibrillation (39% of cases, survival 27%) followed by asystole (36%, survival 0.7%) and pulseless electrical activity (23%, survival 6%).
- Among subjects that underwent resuscitation, the rate of survival to hospital discharge was 12% and overall survival to hospital discharge irrespective of resuscitation was 8%.
- Of the 68 survivors, 16 (24%) received a secondary prevention ICD.