Increased health care utilization prior to sudden cardiac death in the general population

Abstract Background Despite advancements in cardiovascular care, predicting and preventing sudden cardiac death (SCD) in the general population remains a major challenge. Near-term prevention of SCD relies on identifying persons in immediate risk of a lethal arrhythmia before cardiac arrest. This study aimed to evaluate health care contact patterns before SCD and death from other causes, compared to a matched background population. Methods We analyzed the entire Danish population in 2010, identifying SCD cases using Danish death certificates and discharge summaries, yielding 6,767 SCD cases. All deaths in 2010 (n=53,120) were matched with four controls (n=212,480) from the background population based on age, sex, and comorbidities (atrial fibrillation, heart failure, ischemic heart disease, chronic kidney disease, chronic obstructive pulmonary disease, and cancer). We assessed health care contacts both to general practitioners (GP) and hospitals in the year preceding the index date. Logistic regression was used to estimate odds ratios (OR) for health care contact in the 14 days prior to SCD. Results In the year before SCD, weekly health care contact rates increased among cases but remained stable in controls. GP contact rates in controls remained at ~21% per week, whereas among SCD cases, they rose from 24% per week (one year prior) to 39% in the final week before death (Figure 1). Similarly, hospital visit rates increased from 4% to 9% in SCD cases, while remaining stable in controls (Figure 2). There were higher rates of health care utilization, both at hospitals and general practice, in deaths that were non-sudden (Figure 1/2). In the two weeks preceding death, SCD cases had significantly higher odds of GP contact (OR: 4.3, 95% CI: 4.1–4.6) and hospital contact (OR: 3.2, 95% CI: 3.0–3.5) compared to controls. Conclusion Health care contact rates doubled in the year leading up to SCD, with a marked increase in the final weeks. SCD cases were 4.3 times more likely to contact a GP and 3.2 times more likely to visit a hospital in the two weeks before death. These findings highlight the need for improved near-term SCD risk stratification, potentially integrating health care utilization patterns in primary and secondary care in novel SCD prevention strategies.Figure 1 - GP contacts Figure 2 - Hospital visits