Chugh Sumeet S, Jui Jonathan, Gunson Karen, Stecker Eric C, John Benjamin T, Thompson Barbara, Ilias Nasreen, Vickers Catherine, Dogra Vivek, Daya Mohamud, Kron Jack, Zheng Zhi-Jie, Mensah George, McAnulty John
Heart Rhythm Research Laboratory, Division of Cardiology, Oregon Health and Science University, Portland, Oregon 97239, USA.
J Am Coll Cardiol. 2004 Sep 15;44(6):1268-75. doi: 10.1016/j.jacc.2004.06.029.
We sought to determine the annual incidence of sudden cardiac death (SCD) in the general population using a prospective approach. To assess the validity of retrospective surveillance, a simultaneous comparison was made with a death certificate-based method of determining SCD incidence.
Accurate surveillance and characterization of SCD in the general population is likely to significantly facilitate current and future community-based preventive and therapeutic interventions.
We performed a prospective evaluation of SCD among all residents of Multnomah County, Oregon (population 660,486) using multiple sources of surveillance. A comprehensive analysis of circumstances of death, medical records, and available autopsy data was performed. Comparisons were made with a retrospective, death certificate-based determination of SCD incidence using International Classification of Diseases-Version 10 codes and location of death.
Between February 1, 2002, and January 31, 2003, 353 residents suffered SCD (incidence 53 of 100,000; median age 69 years, 57% male) accounting for 5.6% of overall mortality. Of these, 75 cases (21%) were identified using sources other than first responders. Resuscitation was attempted in 237 cases (67%) and successful (survival to hospital discharge) in 28 (8%). The retrospective death certificate-based review yielded 1,007 cases (incidence 153 of 100,000; median age 81 years, 51% male), and the positive predictive value of this methodology was 19%.
Sudden cardiac death accounts for 5.6% of annual mortality, and prospective evaluation in the general population appears to be feasible. The use of multiple sources of ascertainment and information significantly enhances phenotyping of SCD cases. Retrospective death certificate-based surveillance results in significant overestimation of SCD incidence.
我们试图采用前瞻性方法确定普通人群中心脏性猝死（SCD）的年发病率。为评估回顾性监测的有效性，同时与基于死亡证明确定SCD发病率的方法进行比较。
准确监测和描述普通人群中的SCD可能会显著促进当前和未来基于社区的预防和治疗干预措施。
我们对俄勒冈州马尔特诺马县的所有居民（人口660486）进行了SCD的前瞻性评估，使用了多种监测来源。对死亡情况、医疗记录和可用的尸检数据进行了全面分析。使用国际疾病分类第10版编码和死亡地点，与基于死亡证明的SCD发病率回顾性确定方法进行比较。
在2002年2月1日至2003年1月31日期间，353名居民发生了SCD（发病率为每10万人中53例；中位年龄69岁，男性占57%），占总死亡率的5.6%。其中，75例（21%）是通过急救人员以外的来源确定的。237例（67%）尝试了心肺复苏，28例（8%）成功（存活至出院）。基于死亡证明的回顾性审查得出1007例（发病率为每10万人中153例；中位年龄81岁，男性占51%），该方法的阳性预测值为19%。
心脏性猝死占年死亡率的5.6%，在普通人群中进行前瞻性评估似乎是可行的。使用多种确定和信息来源可显著增强SCD病例的表型分析。基于死亡证明的回顾性监测导致SCD发病率被显著高估。
