Sudden cardiac death in Brazil: a community-based autopsy series (2006-2010)

Abstract

Background: Sudden cardiac death (SCD) is a sudden unexpected event, from a cardiac cause, that occurs in less than one hour after the symptoms onset, in a person without any previous condition that would seem fatal or who was seen without any symptoms 24 hours before found dead. Although it is a relatively frequent event, there are only few reliable data in underdeveloped countries.

Objective: We aimed to describe the features of SCD in Ribeirão Preto, Brazil (600,000 residents) according to Coroners' Office autopsy reports.

Methods: We retrospectively reviewed 4501 autopsy reports between 2006 and 2010, to identify cases of SCD. Specific cause of death as well as demographic information, date, location and time of the event, comorbidities and whether cardiopulmonary resuscitation (CPR) was attempted were collected.

Results: We identified 899 cases of SCD (20%); the rate was 30/100000 residents per year. The vast majority of cases of SCD involved a coronary artery disease (CAD) (64%) and occurred in men (67%), between the 6th and the 7th decades of life. Most events occurred during the morning in the home setting (53.3%) and CPR was attempted in almost half of victims (49.7%). The most prevalent comorbidity was systemic hypertension (57.3%). Chagas' disease was present in 49 cases (5.5%).

Conclusion: The majority of victims of SCD were men, in their sixties and seventies and the main cause of death was CAD. Chagas' disease, an important public health problem in Latin America, was found in about 5.5% of the cases.

Figure 1

Study flowchart. * Deaths from other causes: infectious diseases, advanced malignancies, abdominal diseases, cachexia, prolonged bed rest. ** Non-cardiac causes of sudden death: acute aortic syndromes, pulmonary embolism, hemorrhagic stroke, asthma.

Figure 2

SCD rates (per 100,000 inhabitants) in Ribeirão Preto from 2006 to 2010. The mean rate of SCD was 30/100,000 inhabitants per year, ranging from 28/100,000 inhabitants in 2009 to 32/100,000 inhabitants in 2007 and 2008.

Figure 3

Histogram of the temporal variation of SCD. A) Histogram of the circadian variation of SCD. The morning period is the period with the most SCD events (p < 0.05 in comparison to other periods). B) Histogram of the weekly variation of SCD. There was no difference between days of the week (p = 0.79). C) Histogram of monthly variation of SCD. SCD events tended to occur more frequently in the months of May and June, but without statistical significance (p = 0.06).

Figure 4

Proportion of SCD victims submitted to CPR maneuvers in Ribeirão Preto (2006-2010). Altogether, 447 of the 899 victims received CPR (49.7%). There was a clear tendency to an increase in the number of patients that received CPR between 2006 and 2010 (p = 0.05).