Abstract 18106: Community-Based Analysis of Sudden Cardiac Death in Young Adults Age 18-34, in a Large US Population

Abstract

Introduction: Sudden cardiac death in young adults is rare and since existing studies have few subjects, there is a lack of detailed information. We hypothesized that analysis from a large community-based investigation would provide novel mechanistic information.

Methods: In an ongoing, community-based study of prospectively-identified SCD cases in the Northwest US (2002 - 2011), cases aged 18 - 34 were compared with patients aged 35 - 59, and 60 or older. All cases were adjudicated by review of arrest circumstances and physician records. Cases with non-cardiac causes of SCD and terminal illnesses were excluded. Clinical history prior to arrest across the three age groups was compared using χ² tests.

Results: Patients aged 18-34 (n=134, 59% male) made up 5% of the total 2740 cases ascertained, while patients aged 35-59 made up 36% (n=996, 75% male) and patients 60 or older made up 59% (n=1610, 62% male). Young patients were less likely to have physician records available for review (51% vs. 59% and 69%, respectively). In the subset with available physician records, young and middle-aged patients were more likely than older patients to smoke (54%, 56%, and 29%, p<0.0001) and be obese (47%, 47%, and 33%, p<0.0001). The prevalence of documented hypertension, diabetes, heart failure, chronic renal insufficiency, and chronic obstructive pulmonary disease increased by age category (p<0.0001), whereas psychiatric conditions were more common in younger patients (schizophrenia 4.4%, 3.6%, and 1.6%, p=0.02; bipolar disorder 10%, 3%, and 1%, p<0.0001; depression 29%, 20%, 14%, p=0.0002). A history of seizures and asthma was also more common in younger patients (p≤0.002). Older patients were more likely to have been taking anti-hypertensives, beta-blockers, ACE inhibitors, lipid lowering medications, statins, and dixogin prior to arrest (p<0.0001), while younger patients were more likely to have been taking antipsychotics, anti-depressants, and anti-seizure medications (p≤0.01).

Conclusions: Younger adults with SCD were distinguishable by a significantly higher prevalence of schizophrenia, bipolar disorder and depression along with other specific conditions that merit further detailed evaluation.