Reducing mortality from sudden cardiac death in the community: lessons from epidemiology and clinical applications research

The reduction of mortality from sudden cardiac death (SCD) in the community remains a challenge. Clinical-epidemiologic studies have identified a rang e of factors that are associated with an increased risk of SCD. While of po tential etiologic and prognostic importance. these factors have limited sen sitivity and a low positive predictive value for SCD. On the other hand, cl inical trials have suggested that a variety of interventions, including ris k factor reduction, nutritional interventions, drug therapies, cardiac proc edures. and new technologies, have the potential to reduce mortality from S CD. In this review, we examine what is known about the epidemiology and cli nical application of interventions to reduce mortality from SCD; and, we co nsider the impact of both prevention and clinical interventions on mortalit y from SCD from a community perspective. There is mounting evidence that su pports both public health and clinical efforts to prevent the occurrence of SCD. There also is evidence suggesting that new technologies, such as auto mated external defibrillators, have the potential to reduce case-fatality f rom SCD. Further progress will depend on improved methods to identify perso ns-at-risk, reduction of risk factors, and application of techniques - both simple and advanced - to improve survival in victims of SCD. (C) 2001 Publ ished by Elsevier Science B.V.