• epidemiology

Despite advances in prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) remains a major public health issue with profound impact on total and premature mortality. SCD is responsible for almost 15% of all cardiac deaths as well as for 40%–50% of years of potential life lost from heart disease, exceeding the respective premature death burden of all individual cancers and most other leading causes of death.1 What is often unappreciated is that the sudden loss of a loved one also poses an unprecedented psychological burden on the victim’s family and friends, leading to anxiety, prolonged grief and even post-traumatic stress symptoms.

SCD is defined as a non-traumatic, unexpected fatal event occurring within 1 hour of symptom onset in an apparently healthy subject, while if death is unwitnessed, the victim must have been in good health 24 hours before the event. Its diagnosis is challenging due to inherent caveats in case ascertainment. The availability of sufficient clinical information to determine the mode and timing of death is important for a valid documentation of SCD and for calculating the respective incidence accurately. In most studies, determination of SCD is based on death certificate data where subjects, having died out of hospital environment, are classified under specific diagnostic codes from the International Classification of Diseases. This methodology, however, results in overestimation of SCD incidence due to inaccuracies in death certificate diagnoses.2 3

Ågesen et al 4 have evaluated the incidence, sex differences and temporal trends of SCD in a longitudinal community-based cohort in Copenhagen …