umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Sudden cardiac death among the young in Sweden 1992-1999: from epidemiology to support of the bereaved
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Sudden cardiac death (SCD) in a young person is a rare but tragic event, and the potential of prevention is unknown. The aim of this thesis is to contribute to the prevention by analysing SCD in the young in Sweden during the period 1992-1999. Data of SCD in the young based on a national registry is not previously reported. The approach is broad, covering the spectrum from epidemiology to supportive needs of families confronted with SCD. The survey methods comprised analyses of national registries, questionnaires, personal interviews, forensic-, police-, medical- and military conscription records.

The SCD group selected from the database of the National Board of forensic Medicine consisted of 181 persons, 15 to 35 years old, who had suffered an SCD during 1992-1999 in Sweden, 132 men (73 %) and 49 women (27 %). The mean incidence was 0.93 per 100,000 per year. The trend showed no decrease during the surveyed years, 1992-1999. The most common diagnoses were the structurally normal heart (21 %), coronary artery disease (18 %), and dilated cardiomyopathy (12 %). In a study group of 162 individuals (19 cases of aortic aneurysm, 17 men and two women, were excluded), ECGs, symptoms and lifestyle factors were analysed and related to the autopsy findings.

ECGs were available in 66 individuals (59 men and seven women) and 50 % of these were pathological. The most frequent aberrations were repolarisation abnormalities and in half of the cases with more than one ECG a development in a pathological direction was seen. In four out of ten seeking medical advice because of symptoms an ECG was taken and three of these were pathological. Possibly cardiac-related alpitations were common, but also non-specific symptoms such as fatigue after an influenza- like illness. It was not possible to link a certain sign or symptom to a specific diagnosis. In 26 (16 %) there was a family history of SCD.

Physical activity and body mass index (BMI) in men were the same as in a control group, whilst women had a higher BMI and a lower level of physical activity than the controls. In coronary artery disease deaths there were a high percentage of smokers and BMI was higher than in the controls in both sexes. Competing athletes more often died during physical activity than non-athletes, but were not overrepresented in the SCD group. The majority of the athletes who died during physical activity had an underlying structural cardiac disease. Death during sleep was the most common mode of death in subjects with structurally normal heart.

A lack of supportive structures in the handling of bereaved relatives were disclosed in the interviews. Most participants felt that they had been left mainly to themselves to find information and support. A common reflection from the bereaved was that there is a need of the same supportive routines in cases of a single death as in accidents where there are several casualties. The bereaved had a need of getting an explanation and a need of supportive structures. The cognitive dimension of understanding and the emotional dimension of being understood were found to be significant for the complex processes of mourning and recreating one’s life as a bereaved.

In summary, SCD was uncommon in the young, but the incidence was not decreasing during the study period. The most common autopsy findings were the structurally normal heart and coronary artery disease. Symptoms preceding SCD were common but often misinterpreted. The SCD group was very similar to the normal population with regard to life style factors. In certain cardiac disorders physical activity seemed to trigger sudden death, whilst in others death during sleep was the most common mode of death. There is no single test which predicts if a person is at risk of SCD. A further cardiac evaluation in cases with pathological ECGs, and in cases with a positive family history or serious unexplained symptoms such as syncope, might permit the early identification of persons at risk of SCD. ECG is an underused tool in the investigation of symptoms, and a database with old ECGs available for comparison could be useful in the prevention of SCD. There is a need of better care of the bereaved, and based on our findings we propose the introduction of a supportive program.

Place, publisher, year, edition, pages
2005. , 50 p.
Keyword [en]
Epidemiology, Symptoms, Sudden cardiac death, Young, Prevention, Sweden, Electrocardiogram, Forensic diagnosis, Athletic activities, Risk factors, Familiy, Bereavement
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-571OAI: oai:DiVA.org:umu-571DiVA: diva2:143832
Public defence
2005-05-25, Aulan, Sunderby sjukhus, 10:00 (English)
Opponent
Available from: 2005-08-24 Created: 2005-08-24 Last updated: 2009-11-24Bibliographically approved
List of papers
1. Sudden cardiac death in 15-35-year olds in Sweden during 1992-99.
Open this publication in new window or tab >>Sudden cardiac death in 15-35-year olds in Sweden during 1992-99.
2002 (English)In: Journal of Internal Medicine, ISSN 0954-6820, Vol. 252, no 6, 529-536 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study the incidence, pathogenesis and symptoms preceding sudden cardiovascular death amongst 15-35-year olds without substance abuse in Sweden during 1992-99. DESIGN: This was a register study of a national database of forensic medicine, Rattsbase. Clinical details were obtained from forensic, police and medical records and from interviews with family members. SETTING: The whole nation of Sweden. SUBJECTS: Individuals having suffered a sudden cardiac death. RESULTS: We found 181 cases of sudden cardiovascular death in a nationwide database, Rattsbase, in 15-35-year olds, of which 132 (73%) were male and 49 (27%) were female, and a rather stable incidence of 0.93 per 100,000 per year. Preceding symptoms were seen in half of the cases. The most common forensic diagnoses were: no structural abnormality (21.0%), coronary atherosclerosis (17.7%), dilated cardiomyopathy (12.2%), hypertrophic cardiomyopathy (10.5%) and myocarditis (10.5%). CONCLUSION: Sudden cardiovascular death was uncommon in the young, but the incidence was not decreasing. Postmortem diagnoses were often difficult to establish. There was a high frequency of structurally normal hearts. Because premortal cardiac-related symptoms are relatively common and treatment methods are developing, we should learn to recognize early symptoms of heart disease. To identify individuals at risk, further studies of preceding symptoms, life-style factors and electrocardiogram (ECG) changes are needed.

Identifiers
urn:nbn:se:umu:diva-4640 (URN)10.1046/j.1365-2796.2002.01038.x (DOI)12472914 (PubMedID)
Available from: 2005-08-24 Created: 2005-08-24Bibliographically approved
2. Sudden cardiac death in the young in Sweden: electrocardiogram in relation to forensic diagnosis.
Open this publication in new window or tab >>Sudden cardiac death in the young in Sweden: electrocardiogram in relation to forensic diagnosis.
Show others...
2004 (English)In: Journal of Internal Medicine, ISSN 0954-6820, Vol. 255, no 2, 213-220 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study electrocardiogram (ECG) in relation to forensic diagnosis in young persons who suffered a sudden cardiac death (SCD) in Sweden during 1992-99. DESIGN: A register study of a national database of forensic medicine in Sweden, selecting all cases of SCD 15-35 years of age. In this group, 12-lead ECGs and clinical data were searched for in military conscription and medical records. The ECGs were re-analysed and classified according to the Minnesota code criteria. SETTING: The whole nation of Sweden. SUBJECTS: Sudden cardiac death victims (66 individuals), 15-35 years of age, where it was possible to obtain an ECG recording. RESULTS: We observed major or minor ECG abnormalities in 82% of the subjects. The most common changes were T wave abnormalities (35%), ST segment changes (32%) and conduction defects (20%). The ECGs were evaluated as pathological in 50% of the cases, more often in arrhythmogenic right ventricular cardiomyopathy (88%) and hypertrophic cardiomyopathy (82%). Cardiac-related symptoms were seen in 76% of the total group and there was a family history of a similar cardiac condition in 18%. CONCLUSIONS: Pathological ECGs were common in young SCD victims, in spite of being taken many years before death. An ECG could help identify prospective victims of SCD, and should always be taken in cases with possible cardiac-related symptoms or a family history of SCD. The pathological ECGs were often found in connection with routine screening at military enlistment for men, which raises the question of a routine screening in the young, including women.

Keyword
Adolescent, Adult, Arrhythmia/complications, Death; Sudden; Cardiac/*etiology, Electrocardiography, Female, Heart Block/complications, Humans, Male, Registries, Risk Factors, Sex Factors
Identifiers
urn:nbn:se:umu:diva-13197 (URN)10.1046/j.1365-2796.2003.01277.x (DOI)14746558 (PubMedID)
Available from: 2008-01-11 Created: 2008-01-11 Last updated: 2009-11-24Bibliographically approved
3. Symptoms preceding sudden cardiac death in the young are common but often misinterpreted.
Open this publication in new window or tab >>Symptoms preceding sudden cardiac death in the young are common but often misinterpreted.
2005 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 39, no 3, 143-149 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To identify patients at risk of sudden cardiac death (SCD) by analysis of clinical history. DESIGN: A retrospective study of the Swedish cohort of 15-35 year olds having suffered an SCD during 1992-1999 and having undergone a forensic autopsy (162 individuals). We sought information in forensic, police and medical records and from interviews with family members. RESULTS: Syncope/presyncope, chest pain, palpitations or dyspnoea were present in 92/162, unspecific symptoms such as fatigue, influenza, headache or nightmares in 35/162. Syncope/presyncope was most common (42/162). In 74 seeking medical attention, 32 had an ECG recorded (24 pathological). In 26 subjects there was a family history of SCD. CONCLUSIONS: The patient seeking medical advice before suffering an SCD is characterized by one to three of the following: 1) cardiac-related symptoms or non-specific symptoms often after an infectious disease, 2) a pathological ECG, 3) a family history of SCD. In 6 out of 10 a cardiac diagnosis was not considered. We conclude that symptoms preceding SCD were common but often misinterpreted.

Keyword
Adolescent, Adult, Age Factors, Databases, Death; Sudden; Cardiac/etiology/*prevention & control, Female, Forensic Medicine, Humans, Interviews, Male, Questionnaires, Registries, Risk Assessment, Risk Factors, Sweden, Syncope/diagnosis/genetics
Identifiers
urn:nbn:se:umu:diva-15043 (URN)10.1080/14017430510009168 (DOI)16146977 (PubMedID)
Available from: 2007-06-25 Created: 2007-06-25 Last updated: 2009-11-24Bibliographically approved
4. Young Swedish patients with sudden cardiac death have a lifestyle very similar to a control population
Open this publication in new window or tab >>Young Swedish patients with sudden cardiac death have a lifestyle very similar to a control population
2005 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 39, no 3, 137-142 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study the association between lifestyle and sudden cardiac death (SCD) in the young with special respect to athletic activities. DESIGN: We compared lifestyle factors, collected from forensic and medical reports and from interviews with family members, in the Swedish cohort of individuals 15-35 years of age who had suffered an SCD during 1992-1999, with those of the control population of the same age group, obtained from national health registries. RESULTS: Physical activity and body mass index (BMI) in men were the same as in the controls, whilst women had a higher BMI and a lower level of physical activity in the SCD group. Twenty-three per cent (32/138) were competing athletes in the SCD group and 29% in the control group (622/2131). Death during physical activity was more common in athletes (20/32) than in non-athletes (18/106) (p<0.001). In coronary artery disease deaths, 11/15 (73%) were smokers and BMI was significantly higher than in the controls in both sexes. CONCLUSIONS: Young Swedish persons suffering SCD were very similar to the normal population with regard to lifestyle factors.

Identifiers
urn:nbn:se:umu:diva-4643 (URN)10.1080/14017430510009177 (DOI)16146976 (PubMedID)
Available from: 2005-08-24 Created: 2005-08-24Bibliographically approved
5. Understanding and being understood: Supportive needs of families confronted with sudden cardiac death.
Open this publication in new window or tab >>Understanding and being understood: Supportive needs of families confronted with sudden cardiac death.
Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-4644 (URN)
Available from: 2005-08-24 Created: 2005-08-24 Last updated: 2010-01-13Bibliographically approved

Open Access in DiVA

fulltext(502 kB)1447 downloads
File information
File name FULLTEXT01.pdfFile size 502 kBChecksum SHA-1
29e60ed6f50c9826883a02563d5d624ce73db1671be5a62e6790997c4b25ae9c341a68c3
Type fulltextMimetype application/pdf

By organisation
Public Health and Clinical Medicine
Public Health, Global Health, Social Medicine and Epidemiology

Search outside of DiVA

GoogleGoogle Scholar
Total: 1447 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

urn-nbn

Altmetric score

urn-nbn
Total: 1251 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf