Key result
Sudden cardiac arrest incidence reaches ~35 per 100,000 person-years, driven primarily by coronary heart disease.
Why the study?
The epidemiology of sudden cardiac arrest in the Mediterranean area remains unclear.
Observational (n=639)
Yes
A prospective registry using multiple data sources found a relatively low incidence of sudden cardiac arrest (34.8 per 100,000 person-years) and a lower burden of coronary heart disease in the western Mediterranean region compared with northern Europe and North America.
Informs regional EMS and prevention planning; leaves open whether Mediterranean factors explain lower incidence than northern Europe.
Background The epidemiology of sudden cardiac arrest (SCA) in the Mediterranean area remains unclear. The aim of this study is to determine the incidence, causes and characteristics of SCA in this setting. Methods A prospective registry of out-of-hospital cardiac arrests from multiple sources of information was carried out in the Tarragona region (western Mediterranean) with a population of 610 865 inhabitants between 2014 and 2017. The attending clinician assessed the cases on-site. SCA was defined as an unexpected out-of-hospital cardiac arrest, with a presumed cardiac cause, occurring within 1 hour of symptom onset or seen in good condition within the last 24 hours. Data were obtained from the emergency medical service, forensic autopsies, hospitals and primary care centres. Results A total of 639 SCAs were collected. The incidence was 34.8 (95% CI 32.2 to 37.6) cases per 100 000 person-years. The mean age was 66.9 (SD 15.6) years, and 70.1% were male. 20.5% did not receive a cardiopulmonary resuscitation (CPR) attempt. Investigations for the aetiology of cardiac arrest were conducted in hospitals in 20.3% of cases and through forensic autopsies in 36.4%. Of all SCAs with a presumed cardiac cause, 55.5% had a known cause, of which 85.3% were cardiovascular (69.8% cardiac, 15.5% cardiovascular non-cardiac and 14.6% non-cardiovascular). More cardiac causes were recorded in hospitalised patients than in forensic cases (76.9% vs 66.4%, p = 0.042). Coronary heart disease (45.6%) was the main cause, with chronic coronary heart disease (24.5%) being the most frequent type. Cases with a non-cardiac cardiovascular cause presented similar cardiovascular risk factors compared with cases with a cardiac cause. Survival was 10.2%. Chest pain prior to collapse and the use of automatic external defibrillators were associated with survival. Conclusion In this western Mediterranean region, a low incidence of SCA and a low burden of coronary heart disease were found. A comprehensive, multidisciplinary approach is needed to prevent SCA.
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Azeli et al. (2025) conducted an observational in Sudden cardiac arrest (n=639). Out-of-hospital sudden cardiac arrest was evaluated on Incidence of sudden cardiac arrest per 100,000 person-years (95% CI 32.2-37.6). The incidence of sudden cardiac arrest in this western Mediterranean region was 34.8 cases per 100,000 person-years, with coronary heart disease as the main cause.
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