The magnitude of sudden cardiac death in the young: a death certificate-based review in England and Wales

In the UK, the true impact of cardiac and sudden death in the young (< 35 years) is speculative. The authors critically appraised the office of national statistics (ONS) data for causes of death in the 1-34 years age group in England and Wales in an attempt to present an estimate of the incidence of such deaths and their underlying causes. The investigators analysed the ONS mortality data for 2002-2005, inclusive. International classification of diseases-10 codes representing possible cardiac deaths were selected and divided into four classes; A1: definite cardiac deaths with no structural heart disease identified at post-mortem, A2: definite cardiac deaths with structural heart disease identified at post-mortem, A3: definite cardiac deaths with indeterminate cause, and B: possible cardiac deaths. Analysis of the data revealed an average of 419 (SD 16.5) definite cardiac deaths per annum (Class A1 + A2 + A3) equating to 1.8 per 100 000 per year (SD 0.08) or 8 deaths/week. There were also 433 (SD 6.2) deaths per year in class B which comprised primarily of deaths from drowning and epileptic seizures. The most prevalent causes were ischaemic heart disease (33.5%), cardiomyopathies (27%), sudden arrhythmic death syndrome (14%), myocarditis (11%), valvular heart disease (5%), and hypertensive cardiomyopathy (2%). Our findings suggest that the number of cardiac and sudden deaths in the young identified is sufficiently high to command attention even without the inclusion of potential misclassifications (Class B). Awareness of such deaths among primary-care physicians, pathologists, and coroners should be raised to ensure that those at risk are identified and further tragedies are avoided.