Differences among young unwitnessed sudden cardiac death, according to time from last seen alive: Insights from a 15-year nationwide study

• Published in: Heart rhythm Vol. 20; no. 11; pp. 1504 - 1509
• Main Authors: Hansen, Carl Johann, Svane, Jesper, Lynge, Thomas Hadberg, Stampe, Niels Kjær, Bhardwaj, Priya, Torp-Pedersen, Christian, Banner, Jytte, Tfelt-Hansen, Jacob, Winkel, Bo Gregers
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2023
• Subjects: Epidemiology; Forensic autopsy; Prevention; Sudden cardiac death; Sudden death; Forensic autopsy; Prevention; Sudden cardiac death; Epidemiology; Sudden death
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2023.07.005

More than half of all sudden cardiac deaths (SCDs) are unwitnessed, but the composition of the unwitnessed SCD population is poorly described. The purpose of this study was to compare clinical and autopsy characteristics of young unwitnessed SCD subjects, based on the time from last contact to being found dead. All unwitnessed SCD subjects aged 1–35 years in Denmark from 2000–2014 identified through a multisource approach were included. Time from last seen alive to being found dead was dichotomized to <1 hour or 1–24 hours. Clinical characteristics and autopsy results were compared, and predictors of autopsy were assessed by logistic regression. Of 440 unwitnessed SCD subjects, 366 (83%) had not been seen alive within 1 hour of being found dead. Comorbidities differed between the groups, with more epilepsy (17% vs 5%) and psychiatric diseases (13% vs 7%) in the 24-hour group. Patients in the 24-hour group died more frequently during sleep (64% vs 23%), the autopsy rate was higher (75% vs 61%), and deaths were more often unexplained after autopsy (69% vs 53%). Having been seen within 1 hour of death independently decreased the chance of being autopsied (odds ratio 0.51; 95% confidence interval 0.27–1.00; P = .0497). The majority of unwitnessed SCD subjects had not been seen alive within 1 hour of being found dead. Clinical- and autopsy-related characteristics differed between the 2 groups. Differences were mainly attributable to death-related circumstances and comorbidities. Excluding SCD cases not seen alive within 1 hour of being found dead would severely underestimate the burden of SCD. [Display omitted]