Key result
~69% of young HCM sudden cardiac death victims sought medical care within 180 days prior.
Why the study?
Hypertrophic cardiomyopathy is a major cause of sudden cardiac death in the young, prompting the need to characterize family history, symptoms, hospital utilization, and ECG changes prior to sudden cardiac death.
Observational (n=38)
Absolute Event Rate: 69% vs 21%
p-value: p=<0.001
Most young individuals who suffer sudden cardiac death due to hypertrophic cardiomyopathy present with symptoms, ECG abnormalities, or seek medical care prior to death, highlighting the need for broader cardiac screening.
May prompt symptom evaluation in young patients; hypothesis-generating for HCM screening to avert SCD.
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a major cause of sudden cardiac death (SCD) in the young. We aimed to characterize detailed family history, symptoms, hospital utilization and ECG changes before SCD. METHODS: We extracted all cases suffering SCD with HCM from the SUDDY cohort, which includes all cases of SCD between 2000-2010 in Sweden among individuals aged 0-35 years along with their controls. We gathered data from mandatory national registries, autopsy reports, medical records, ECGs (including military conscripts), and detailed family history from an interview-based questionnaire (with relatives, post-mortem). RESULTS: Thirty-eight cases (7 female), mean age 22 years, with HCM were identified. Among these, 71% presented with possible cardiac symptoms (chest pain [26%], syncope [22%], palpitations [37%]), before death; 69% received medical care (vs 21% in controls) within 180 days before death. The majority (68%) died during recreational activity (n = 14) or exercise/competitive sports (n = 12). Fifteen (39%) had a known cardiac disorder prior to death, with HCM being diagnosed pre-mortem in nine cases. 58% presented with abnormal ECG recordings pre-mortem, and 50% had a positive family history (1st-3rd generation) for heart disease. CONCLUSION: In this comprehensive, nationwide study of SCD due to HCM, 87% (33/38) of cases had one or more abnormality prior to death, including cardiac symptoms, a positive family history, known cardiac disease or ECG abnormalities. They sought medical care prior death, to a larger extent than controls. These findings suggest that cardiac screening should be expanded beyond competitive athletes to aid SCD prevention in the young population with HCM.
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Börjesson et al. (2022) conducted an observational in Hypertrophic cardiomyopathy and sudden cardiac death (n=38). Among young individuals suffering sudden cardiac death from hypertrophic cardiomyopathy, 69% sought medical care within 180 days prior to death compared to 21% of matched controls.
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