The Role of Drugs in Prevention of Sudden Cardiac Death
Presentation Overview
♥ Sudden Cardiac Death
Epidemiology, etiology, pathophysiology
♥ Overview of ICD therapy to prevent SCD
General adult population
Multiple risk subgroups
Patients with any previous coronary event
Patients with ejection fraction <35% or CHF
MADIT II SCD-HeFT
Cardiac arrest, VT/VF survivors
♥ Roles of Drugs in SCD Prevention
♥ Summary and conclusions
Epidemiology of SCD
Accounts for 63% of all cardiac related deaths in the US. One of the most common causes of death in developed countries:
5% Other 15% Cardiomyopathy
80% Coronary Heart Disease
American Heart Association. Heart Disease and Stroke Statistics—2003 Update. Dallas, Tex.: American Heart Association; 2002. Adapted from Heikki et al. N Engl J Med, Vol. 345, No. 20, 2001. Myerberg RJ. Heart Disease, A Textbook of Cardiovascular Medicine. 6th ed. P. 895.
Sudden death was the first manifestation of coronary heart disease in 50% of men and 63% of women.
CHD accounts for at least 80% of sudden cardiac deaths in Western cultures.
Thomas Bigger, Lancet,n SCD Prevention
Roles of Drugs in SCD Prevention
Value of Antiarrhythmic Drugs
♥ Class I antiarrhythmics ♥ Beta Blockers ♥ Amiodarone ♥ Sotalol
Magnitude of SCD in China
0.2%
0.1%~0.2%
0.1% 0.04%
0.04%
China
US
Incidence Rate
544,000
300,000 ~350,000
China
US
Absolute Number
Incidence of SCD in Specific Populations
Arrhythmic Cause of SCD
12%Other Cardiac Cause
Bradycardia Torsades de Pointes
16.5%
12.7%
88% Arrhythmic Cause
Primary VT 8.3%
. Albert CM. Circulation. 2003;107:2096-2101
Bayés de Luna A. Am Heart J. 1989;117:151-159.
VF 62.4%
Application of ICD in China
544,000 200
“Even the wealthiest nations cannot afford to pay to use every medical advance in any patient who might benefit.”
AVID, CASH, CIDS
High-risk post-MI subgroups
0 5 10 20 25 30
Incidence of SCD (% of group)
MADIT, MUSTT,
100,000 200,000 300,000
Absolute number of SCD Per Year
Adapted from: Myerburg RJ. Sudden Cardiac Death: Exploring the Limits of Our Knowledge. J Cardiovasc Electrophysiol Vol. 12, pp. 369381, March 2001.
Disease Cause of SCD
Geography
Incidence
Worldwide
3,000,000
US
300,000~350,000
W.Europe
400,000
MMWR. Vol 51(6) Feb. 15, 2002. Myerberg RJ, Catellanos A. Cardiac Arrest and Sudden Cardiac Death. In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. 5th Ed. New York: WB Saunders. 1997: 742-779. Zheng Z. Circulation. 2001;104:2158-2163. Vreede-Swagemakers JJ et al. J Am Coll Cardiol 1997; 30: 1500-1505.
Value of Non-antiarrhythmic Drugs