What is the clinical evidence from this study?

Study design: Observational. Population: Cardiomyopathies (n=369570). Intervention: Young adult age (20-39 years) vs. Older age (≥60 years). Primary outcome: Death on public roadway (proxy for sudden cardiac death) (OR 2.88, 95% CI 2.68-3.10, p=<0.001).

What does this research mean for the field?

Despite overall annual declines in cardiomyopathy-related mortality, out-of-hospital deaths have substantially increased and young adults bear a disproportionate burden of premature mortality and sudden cardiac death. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate temporal trends in cardiomyopathy mortality, assess age-related variations in the place of death, and quantify premature mortality using years of life lost.

October 4, 2026ABC Heart Failure & CardiomyopathyOpen Access

Shifting Patterns of Out-Of-Hospital Mortality and Premature Life Loss in Cardiomyopathies: A Nationwide Population-Based Study

Q: What are the key findings of this study?

Young adults aged 20-39 years with cardiomyopathy had significantly higher odds of dying on public roadways compared to those aged 60 years or older (OR 2.88), reflecting a high sudden death burden.

Q: What does this research mean for the field?

Despite overall annual declines in cardiomyopathy-related mortality, out-of-hospital deaths have substantially increased and young adults bear a disproportionate burden of premature mortality and sudden cardiac death. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate temporal trends in cardiomyopathy mortality, assess age-related variations in the place of death, and quantify premature mortality using years of life lost.

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Key result

Young adults with cardiomyopathy linked to ~190% higher odds of roadway death vs older adults.

OR 2.88
95% CI 2.68-3.10
P<0.001
n=369,570

Why the study?

Despite declining mortality rates in cardiomyopathies, shifts in place of death and persistent premature mortality suggest gaps in prevention and access to advanced therapies.

Key Points

To evaluate temporal trends in cardiomyopathy mortality, assess age-related variations in the place of death, and quantify premature mortality using years of life lost.
Analyzed 369,570 nationwide deaths in Brazil occurring between 1996 and 2024 with cardiomyopathy (ICD-10 I42) documented as the underlying cause in an ecological study design.
Evaluated temporal trends using Poisson regression, calculated associations between age categories and place of death via odds ratios, and estimated years of life lost using national life tables.
Age-adjusted mortality decreased by 1.7% annually (p<0.001), while hospital deaths declined from 75% to 43% and home deaths rose from 20% to 38%, with a significant inflection point around 2011.
Public roadway deaths were more frequent in adults aged 20–39 years (4.8%) than those aged ≥60 years (0.8%; OR 2.88, 95% CI 2.68–3.10; OR 1.95, 95% CI 1.85–2.06 for ages 40–59).
Premature mortality reached 6.83 million total years of life lost, with young adults aged 20–39 years accounting for 5.5% of deaths but 12.8% of years of life lost (average 42.9 years lost per death).

Study Design

Type

Observational (n=369,570)

Structured PICO

Population

369,570 deaths in Brazil between 1996 and 2024 with cardiomyopathy as the underlying cause, analyzed to evaluate temporal trends and age-related patterns in place of death.

Outcome

Place of death, categorized as hospital, home, public roadway, other health establishment, other locations, or ignored/unknownhard clinical

Main Result

Odds Ratio: 2.88 (95% CI 2.68–3.1)

Absolute Event Rate: 4.8% vs 0.8%

p-value: p=<0.001

Despite declining overall cardiomyopathy mortality in Brazil, out-of-hospital deaths have increased, with young adults suffering disproportionate premature mortality likely due to sudden cardiac death.

Limitations

Reliance on ICD-10 code I42 may introduce misclassification
Public-roadway deaths were used as a proxy for sudden cardiac death and lack clinical or autopsy confirmation
Aggregated nature of mortality data limits etiological specificity and precludes individual-level adjustment for confounders
Race/ethnicity data were not consistently available in the mortality database
Public-roadway deaths used as a proxy for SCD lack clinical or autopsy confirmation
Aggregated nature of mortality data limits etiological specificity and precludes individual-level adjustment
Race/ethnicity data were not consistently available

Implication

May signal higher out-of-hospital SCD risk in young cardiomyopathy patients; ecological data leave open need for prospective validation.

Abstract

Background: Cardiomyopathies are a major cause of cardiovascular mortality, presenting age-dependent phenotypes ranging from sudden cardiac death (SCD) to progressive heart failure.Despite declining mortality rates, gaps in prevention and access to advanced therapies may manifest as shifts in the place of death and persistent premature mortality.Objectives: To evaluate temporal trends in cardiomyopathy-related mortality in Brazil, assess age-related patterns in the place of death, and quantify premature mortality through years of life lost (YLL).Methods: This nationwide, population-based ecological study analyzed 369,570 deaths in Brazil (1996-2024) in which cardiomyopathy (ICD-10 I42) was the underlying cause.Temporal trends were assessed using Poisson regression, and associations between age and place of death were evaluated using odds ratios (OR).The YLL were calculated using national life tables.Results: Age-adjusted mortality declined by 1.7% annually (p<0.001).Hospital deaths decreased from 75% to 43%, whereas home deaths increased from 20% to 38%, with a significant inflection point around 2011.Public roadway deaths, used as a proxy for SCD, were more frequent among adults aged 20-39 years (4.8%) than among those aged ≥60 years (0.8%; OR 2.88, 95% CI 2.68-3.10).Total YLL reached 6.83 million years.Individuals aged 20-39 years accounted for only 5.5% of deaths but contributed 12.8% of total YLL, averaging 42.9 years lost per death.Conclusions: Despite declining mortality, out-of-hospital deaths have become more frequent.Excess YLL among young adults highlights gaps in SCD prevention.Age-tailored strategies are needed to reduce premature mortality.

Discussion

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Cite This Study

Perazzo et al. (2026) conducted an observational in Cardiomyopathies (n=369,570). Young adult age (20-39 years) vs. Older age (≥60 years) was evaluated on Death on public roadway (proxy for sudden cardiac death) (OR 2.88, 95% CI 2.68-3.10, p=<0.001). Young adults aged 20-39 years with cardiomyopathy had significantly higher odds of dying on public roadways compared to those aged 60 years or older (OR 2.88), reflecting a high sudden death burden.

synapsesocial.com/papers/6ac19d70aeea5716e8c6c6cc https://doi.org/10.36660/abchf.20260024i

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Implication

May signal higher out-of-hospital SCD risk in young cardiomyopathy patients; ecological data leave open need for prospective validation.

Shifting Patterns of Out-Of-Hospital Mortality and Premature Life Loss in Cardiomyopathies: A Nationwide Population-Based Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Shifting Patterns of Out-Of-Hospital Mortality and Premature Life Loss in Cardiomyopathies: A Nationwide Population-Based Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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