Mehra Rahul
Medtronic, Inc, Minneapolis, MN, USA.
J Electrocardiol. 2007 Nov-Dec;40(6 Suppl):S118-22. doi: 10.1016/j.jelectrocard.2007.06.023.
Cardiovascular disease is a leading cause of global mortality, accounting for almost 17 million deaths annually or 30% of all global mortality. In developing countries, it causes twice as many deaths as HIV, malaria and TB combined. It is estimated that about 40-50% of all cardiovascular deaths are sudden cardiac deaths (SCDs) and about 80% of these are caused by ventricular tachyarrhythmias. Therefore, about 6 million sudden cardiac deaths occur annually due to ventricular tachyarrhythmias. The survival rate from sudden cardiac arrest is less than 1% worldwide and close to 5% in the US. Prevention of cardiovascular disease by increasing awareness of risk factors such as lack of exercise, inappropriate diet and smoking has reduced cardiovascular mortality in the US over the past few decades. However, there is still a huge cardiovascular disease burden globally as well as in the US. Therefore, there is a need to develop complementary strategies for management of sudden cardiac death. The data from several trials conclusively indicate that implantable defibrillators improve mortality in patients who have experienced an episode or are at high risk of developing ventricular tachyarrhythmias. These devices are reimbursed and are being used frequently in the developed economies for management of SCD. However, due to that low level of public and private health spending in developing economies and the relatively high cost of ICDs, their implant rates are very low there. The Automatic External Defibrillators and Emergency Medical Response Services equipped with AEDs provide complementary as well as alternative opportunities for management of SCD. There are several challenges associated with the adoption of these strategies. The efficacy and cost-effectiveness of these strategies need to be compared with ICDs to determine the appropriate strategy for various geographies. The global problem of SCD as well as the various options for its management will be discussed in the presentation.
心血管疾病是全球死亡的主要原因，每年导致近1700万人死亡，占全球总死亡率的30%。在发展中国家，其造成的死亡人数是艾滋病毒、疟疾和结核病加起来的两倍。据估计，所有心血管死亡病例中约40%-50%为心源性猝死（SCD），其中约80%由室性快速心律失常引起。因此，每年约有600万例心源性猝死是由室性快速心律失常导致的。全球范围内，心脏骤停后的存活率不到1%，在美国接近5%。在过去几十年里，通过提高对缺乏运动、饮食不当和吸烟等风险因素的认识来预防心血管疾病，已降低了美国的心血管死亡率。然而，全球以及美国仍面临着巨大的心血管疾病负担。因此，需要制定补充策略来管理心源性猝死。多项试验的数据确凿表明，植入式除颤器可降低经历过室性快速心律失常发作或有发生室性快速心律失常高风险患者的死亡率。这些设备可报销，在发达经济体中被频繁用于管理心源性猝死。然而，由于发展中经济体的公共和私人卫生支出水平较低，且植入式心脏除颤器成本相对较高，其植入率在这些地区非常低。自动体外除颤器以及配备自动体外除颤器的紧急医疗响应服务为心源性猝死的管理提供了补充和替代方案。采用这些策略存在若干挑战。需要将这些策略的疗效和成本效益与植入式心脏除颤器进行比较，以确定适合不同地区的策略。本报告将讨论心源性猝死的全球问题及其各种管理方案。
