SUDDEN DEATH IN ARTERIOSCLEROTIC HEART DISEASE - CASE FOR PREVENTIVE MEDICINE

Arteriosclerotic heart disease is the leading cause of death among adults in the United States. The distribution of deaths due to arteriosclerotic heart disease in relation to demographic factors, time, space and medical care has been studied in several different ways. Data from cross-sectional and prospective studies disclose that the incidence of sudden death due to arteriosclerotic heart disease is higher in male than in female subjects and increases with age. Approximately 25 to 30 per cent of patients with incident cases of myocardial infarction die suddenly, and for a cohort of myocardial patients with myocardial infarction there are as many deaths within the first 24 hours as during the next 5 years. A variety of studies in the United States and England have shown that in about 70 per cent of all deaths due to arteriosclerotic heart disease the individuals died outside of a hospital or were dead on arrival. Relatively few of the deaths occur after 24 hours of hospitalization. Survivors of a myocardial infarction have a very high risk of dying suddenly. This risk also may exist for patients with angina pectoris. A retrospective study of sudden death in Baltimore has shown that 60 per cent of all deaths due to arteriosclerotic heart disease were sudden and that 61.4 per cent of all sudden deaths were due to arteriosclerotic heart disease. Sudden death due to arteriosclerotic heart disease was the single most important type of death in subjects aged 40 to 64 years, accounting for 20 per cent of the nontraumatic deaths. Approximately one half of the individuals with arteriosclerotic heart disease dying suddenly had a history of heart disease, and 23 per cent had seen a physician within a week before death. Finally, of the 585 white men who died of arteriosclerotic heart disease, only 52 (8.4 per cent) had died within two hours, had no history of heart disease and had not seen a physician within one month before death. A review of these studies, therefore, shows that either a program of primary prevention of myocardial infarction and sudden death or methods of early diagnosis and treatment outside of the hospital and in a coronary care facility will be necessary to reduce the death rates from arteriosclerotic heart disease in the community. © 1969.