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ACHD/valve disease/pericardial disease/cardiomyopathy
2 Understanding cardiac and sudden death in young individuals: novel insights from the office for national statistics (ONS) in the United Kingdom
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  1. Raghav T Bhatia1,2,
  2. Tee Joo Yeo1,3,
  3. Hamish MacLachlan,
  4. Joyee Basu1,
  5. Nikhil Chatrath1,
  6. Saad Fyyaz1,
  7. Shafik Khoury1,
  8. Sarandeep Marwaha1,
  9. Chris Miles1,
  10. Joseph Westaby1,4,
  11. Maria Teresa Tome Esteban1,
  12. Elijah Behr1,
  13. Aneil Malhotra1,5,
  14. Gherardo Finocchiaro1,
  15. Steve Cox6,
  16. Mary Sheppard1,4,
  17. Sanjay Sharma1,
  18. Michael Papadakis1
  1. 1Cardiovascular Clinical Academic Group, St. George’s, University of London, St. George’s University Hospitals NHS Foundation Trust, UK
  2. 2Hull University Teaching Hospitals NHS Trust, Hull, UK
  3. 3National University Heart Centre Singapore, Singapore
  4. 4CRY Centre for Cardiac Pathology, St George’s, University of London, UK
  5. 5Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, UK
  6. 6Cardiac Risk in the Young, London, UK

Abstract

Background Previous data from the Office for National Statistics (ONS) (2002-2005) reported an incidence of sudden cardiac death (SCD) in the young of 1.8 per 100,000 per year.

Aim We aimed to report on the incidence of cardiac and sudden cardiac death in individuals under the age of 35 years in England and Wales between 2013 and 2021, with the goal of identifying any shifts in incidence and causes of SCD, which has not been previously reported.

Methods Annual ONS mortality data relating to cardiovascular (CV) and possible CV deaths in individuals aged <35 years was analysed according to international classification of diseases-10 (ICD-10) codes. We classified these deaths into four classes; A1: definite cardiac deaths with no structural heart disease identified at post-mortem (consistent with sudden arrhythmic death syndrome, SADS), A2: definite cardiac deaths with structural heart disease identified at post-mortem, A3: definite cardiac deaths with indeterminate cause, and B: possible cardiac deaths. We calculated incidence rates based on ONS census data of the annual resident population for individuals under 35 years of age in England and Wales.

Results Between 2013-2021, there was a mean of 393 (SD 15.4) definite cardiac deaths per annum (classes A1+A2+A3) (table 1). Based on annual census population estimates (mean 25,467,647±220,118.6), this equates to a mean mortality rate of 1.55 per 100,000 individuals per annum or 7.6 deaths/week. The most prevalent conditions were SADS (28%), ischaemic heart disease (26%), cardiomyopathies (24%), myocarditis (10%), aortopathy including aortic dissection (5%), valvular heart disease (3%) and hypertensive heart disease (2%) (figure 1). There was a mean of 518 (SD 40.9) deaths per annum which may have signified a proportion of possible cardiac deaths (class B) and comprised primarily of deaths from epilepsy (32%), sudden infant death syndrome (20%) and drowning (13%). A male preponderance was observed for both definite and possible cardiac deaths; male to female ratios of 2.1:1 and 1.9:1, respectively. Whilst the overall incidence trend of cardiac and SCD showed a progressive decline over 9 years, there was a notable increase from 2020 to 2021 (figure 2). This may reflect the COVID-19 pandemic's impact on preventative strategies.

Conclusions Our study provides novel insights into a decreasing trend in cardiac and SCD among young individuals in the UK. This may be due to preventative measures such as screening and increased awareness and uptake of cardiopulmonary resuscitation, including availability of automatic external defibrillators. Consistent with contemporary studies, SADS is now the most common cause of cardiac death in the young, highlighting the role for expert autopsy. The burden of cardiac and SCD in young individuals underscores the need to expand access to preventative strategies and targeted risk management.

Abstract 2 Figure 1
Abstract 2 Figure 1

Causes of definitive cardiac death in the young (Class A1+A2+A3) expressed as percentage of the total number of definite cardiac deaths (DCM: dilated cardiomyopathy; HCM: hypertrophic cardiomyopathy; HD: heart disease

Abstract 2 Figure 2
Abstract 2 Figure 2

Trends in incidence of definite cardiac and sudden deaths in the young (A1+A2+A3) Incidence quoted as mortality per 100,000 individuals per annum

View this table:
Abstract 2 Table 1

Number of deaths according to class per yearA1: definite cardiac deaths with no structural heart disease identified at post-mortem (termed, sudden arrhythmic death syndrome, SADS), A2: definite cardiac deaths with structural heart disease identified at post-mortem, A3: definite cardiac deaths with indeterminate cause, and B: possible cardiac deaths

Conflict of Interest None

  • Sudden cardiac death
  • Sudden arrhythmic death syndrome
  • Prevention

https://doi.org/10.1136/heartjnl-2023-BCS.2

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