Scope and nature of sudden cardiac death before age 40 in Ontario: a report from the cardiac death advisory committee of the office of the chief coroner

Heart Rhythm. 2013 Apr;10(4):517-23. doi: 10.1016/j.hrthm.2012.12.003. Epub 2012 Dec 8.


Background: Understanding sudden cardiac death in the young may inform prevention strategies.

Objective: To determine the scope and nature of sudden death in a geographically defined population.

Methods: We performed a retrospective population-based cohort study in Ontario, Canada, of all sudden cardiac death cases involving persons aged 2-40 years identified from the 2008 comprehensive Coroner database. Of 1741 Coroner's cases, 376 were considered potential sudden cardiac death cases and underwent review.

Results: There were 174 cases of adjudicated sudden cardiac death from a population of 6,602,680 persons aged 2-40 years. Structural heart disease was present in 126 cases (72%), 78% of which was unrecognized. There was no identifiable cause of death in 48 cases (28%), representing primary arrhythmia syndromes. The majority of decedents were men (76%) over the age of 18 (90%). The overall incidence of sudden cardiac death increased with age from 0.7/100,000 (2-18 years) to 2.4/100,000 (19-29 years) to 5.3/100,000 (30-40 years) person-years. Persons experiencing sudden cardiac death before age 30 were more likely to have a primary arrhythmia syndrome (odds ratio 2.97; P<.001). The majority of events occurred in the home (72%); 33% of the events in children/adolescents and 9% of the events in adults occurred during reported moderate or vigorous exercise (P = .002). There were no pediatric deaths during organized competitive sports.

Conclusions: The incidence of sudden cardiac death increases with age, typically occurring in a man at rest in the home with unrecognized underlying heart disease or a primary arrhythmia syndrome. Prevention strategies should consider targeting identification of unrecognized structural heart disease and primary arrhythmia syndromes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Advisory Committees
  • Age Distribution
  • Canada / epidemiology
  • Cause of Death*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Confidence Intervals
  • Coroners and Medical Examiners*
  • Databases, Factual
  • Death, Sudden, Cardiac / epidemiology*
  • Death, Sudden, Cardiac / etiology*
  • Death, Sudden, Cardiac / prevention & control
  • Female
  • Humans
  • Male
  • Ontario / epidemiology
  • Prevalence
  • Retrospective Studies
  • Risk Assessment
  • Sex Distribution
  • Young Adult