MP-453090-5 SUDDEN CARDIAC ARREST AS THE FIRST MANIFESTATION OF HEART DISEASE IN THE GENERAL POPULATION

Abstract

The subgroup of individuals who present with sudden cardiac arrest (SCA) as the first manifestation of heart disease (FM-SCA) present the greatest challenge to effective clinical risk stratification, but population-based data in the current era is lacking. We hypothesized that improved awareness and access to health care has resulted in a reduction in prevalence of FM-SCA. We compared the prevalence secular trends of FM-SCA in two geographically distinct US populations and evaluated distinguishing characteristics. Consecutive cases of SCA were ascertained prospectively from 2 large ongoing US studies, the Oregon Sudden Unexpected Death Study (OreSUDS, Portland OR, USA, 2002-2018) and Prediction of Sudden Death in Multi-ethnic Communities (PRESTO, Ventura CA, USA, 2015-2022), total population 1.85 million residents. All out-of-hospital SCA events attended by emergency medical services were determined following an established multi-source ascertainment and adjudication process, and a detailed review of the comprehensive lifetime clinical records was conducted for each individual. Both SCA survivors and non-survivors were included. FM-SCA cases were defined as SCA with no prior heart disease diagnosis. A multi-variable model using combined data from both cohorts was used to identify distinguishing characteristics of FM-SCA vs. other SCA. A total of 3390 SCA cases (age 64.3 ± 18.8, female 34%) were identified in OreSUDS and n=2318 (age 71.6 ± 15.7, female 36%) in PRESTO. In OreSUDS, prevalence of FM-SCA was 39% (n=1282, age 58.6 ± 21.7, 32% female) and decreased modestly over time (Figure; 37% in 2002-06 to 33% in 2014-18; p=0.001 for trend). In PRESTO, overall prevalence of FM-SCA was 41% (n=949, age 68.3 ± 17.6, 33% female) and did not change significantly over time (Figure; 2015-2022; p=0.06 for trend). In multivariate comparisons of FM-SCA vs. other SCA performed in the subset of individuals with healthcare visits, younger age, male sex and lower rates of diabetes, hypertension, seizure disorder, chronic obstructive pulmonary disease and chronic renal insufficiency were associated with FM-SCA (p <0.0001). There was a modest reduction in prevalence over time, but 33-41% of individuals continued to present with FM-SCA and were distinguished by younger age, male sex and lower rates of co-morbid conditions. These findings suggest the need to develop and investigate user-friendly and cost-effective pre-screening methods to reduce FM-SCA in the general population.