Key result
Most sudden cardiac deaths occur in the general population despite a low ~0.2% annual incidence.
Why the study?
Sudden cardiac death accounts for 15%-20% of overall mortality with poor survival, and accurately predicting risk in the general population where most events occur remains a major challenge.
This review highlights the epidemiologic paradox of sudden cardiac death and emphasizes the need for multiparametric, AI-driven approaches for personalized risk prediction in the general population.
Limits effectiveness of current high-risk SCD targeting; leaves open AI-driven personalized prediction in the general population.
ARTICLE SCD prevention strategies: present and future 1 risk factors varies with age.In young people, it is predominantly due to channelopathies, cardiomyopathies, and myocarditis, while in older populations the main risk factor is CAD. Predicting and preventing sudden cardiac death:the epidemiologic paradox The paradox regarding relative risk vs absolute event count has been described in the 1990s by Zipes and Wellens 13 : individuals at the highest risk (those with a history of malignant ventricular arrhythmias [VAs] in the context of structural heart disease) only account for a limited number of the total SCDs per year (FIguRE 1).The incidence in the general population without known heart disease is relatively low (0.1%-0.2% per year), however, a majority of SCD events occur in this group.Therefore, therapeutic measures addressing patients in small high -risk subgroups (easier to identify) only have a limited overall impact on the total number of SCDs.The accurate prediction of SCD risk in the general population remains a major challenge with a chance to significantly reduce SCD burden.Ongoing studies based on big data and artificial intelligence suggest that personalized prediction of SCD may be based on a multiparametric approach involving a combination of multiple specific markers. 14Introduction Sudden cardiac death (SCD) accounts for 15%-20% of overall mortality, has an estimated annual burden of 4-5 million cases, and therefore is a public health problem of great magnitude. 1-3Due to its unexpected nature, it is still associated with poor overall survival (<10%). 4,5However, a lot has been done by the scientific and public health community to improve prevention and early response strategies (resuscitation) both at the individual and population level. 6-8Preventive measures have focused on identifying high -risk individuals among patients with known underlying electrical or structural heart disorders and preventing coronary artery disease (CAD) responsible for nearly 70% of SCDs. 9-11On the population level, public initiatives have aimed at raising awareness and educating people on recognition of cardiac arrest (CA) and early intervention steps. 6 -8,12 The most common cause of SCD is ischemic heart disease (IHD), and its consequences (acute myocardial ischemia, scarring from previous myocardial infarction [MI], heart failure [HF]) manifest in 80% of SCD victims.Dilated nonischemic and hypertrophic cardiomyopathy (HCM) are the next more common causes of SCD, whereas other cardiac disorders, including congenital heart defects and ion channel anomalies, account for 5%-10% of SCD cases.The spectrum of SCD
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Bricoli et al. (2024) conducted a review in Sudden cardiac death. Sudden cardiac death prevention strategies face an epidemiologic paradox where the majority of events occur in the general population despite a low annual incidence of 0.1%-0.2%.
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