Key result
Neuropsychiatric factors like epilepsy and antipsychotic use predict SCA in patients ≤40 with AUC 0.74.
Why the study?
Sudden cardiac arrest in young adults has low survival rates and often lacks well-identified risk factors, necessitating improved understanding to identify individuals at risk.
Do neuropsychiatric factors predict sudden cardiac arrest in young adults?
Do neuropsychiatric factors predict sudden cardiac arrest in young adults?
Neuropsychiatric conditions and treatments, such as epilepsy and antipsychotic or anxiolytic use, are significant predictors of sudden cardiac arrest in young adults, suggesting a need to expand risk stratification beyond traditional cardiovascular factors.
Neuropsychiatric factors may aid SCA prediction in adults ≤40; hypothesis-generating and requires prospective validation before clinical adoption.
Background Sudden Cardiac Arrest (SCA) in young adults is a significant public health issue, with survival rates often less than 15%. In young adults, most SCA arise from patients for whom there are no well-identified risk factors. Strengthening our understanding of SCA in young adults is therefore essential for identifying those at risk and developing interventions to reduce its incidence. Methods We conducted a case-control study using electronic health records (EHRs) from 89,040 individuals in one city and its suburbs (2011–2020). We included 4,244 prospectively collected patients aged ≤ 40 years and 84,796 aged > 40 years, with a 1:3 case-controls matching on age, sex, and residence. We trained Explainable Boosting Machine (EBM) models on medical diagnoses and prescriptions from the five years preceding SCA. Model performance was assessed using AUC, sensitivity, specificity, and feature importance, stratified by age groups. Results For patients aged ≤40 years, neuropsychiatric factors, including antipsychotics, anxiolytics, and epilepsy emerged as key predictors of SCA, whereas cardiovascular factors were the primary predictors in the older group. The younger cohort’s model achieved an AUC of 0.74 (95% CI: 0.70–0.78). The older cohort’s model had an AUC of 0.80 (95% CI: 0.79–0.81). Both models demonstrated robust calibration, and sensitivity analyses confirmed consistent findings across various feature subsets and hyperparameter settings. Conclusion These findings underscore the crucial role of neuropsychiatric factors in risk stratification among younger individuals. By highlighting risk markers such as epilepsy and the use of antipsychotics or anxiolytics, our results call for greater interdisciplinary collaboration to expand current SCA conception beyond the strict cardiac domain. Future research should investigate non-cardiac markers to refine SCA risk stratification and explore non-cardiac contributors to better understand young and undiagnosed cases.
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Laurenceau et al. (2025) studied this question. In patients ≤40, neuropsychiatric factors like epilepsy and antipsychotic/anxiolytic use predicted SCA with AUC 0.74, highlighting non-cardiac risk markers.
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