Epidemiology of sudden cardiac death in rural South India - insights from the Andhra Pradesh rural health initiative

Srinivas Madhavan, Sathish Reddy, Pradeep Panuganti, Rohina Joshi, Jaya Mallidi, Krishnam Raju, Srinivas Iyengar, Kolli Reddy, Anushka Patel, Bruce Neal, Narasimhan Calambur, Harikrishna Tandri

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    Abstract

    Background: Sudden cardiac death (SCD) is a common initial presentation of coronary artery disease (CAD). Despite the growing epidemic of CAD in India, the epidemiology of SCD is largely unknown. Objective: The objective of the study was to define the prevalence and determinants of sudden cardiac deaths in rural South India. Methods: Prospective mortality surveillance was conducted in 45 villages (180,162 subjects) in rural South India between January 2006 and October 2007. Trained multipurpose health workers sought to do verbal autopsies within 4 weeks of any death. Detailed questionnaires including comorbidities and circumstances surrounding death were recorded. SCD was adjudicated using the modified Hinkle-Thaler classification. Results: A total of 1916 deaths occurred in the study population over the 22 month time period and verbal autopsy was obtained in 1827 (95%) subjects. Overall mean age of the deceased was 62 ± 20 years and 1007 (55%) were men. Cardiovascular and cerebrovascular diseases together accounted for 559 deaths (31%), followed by infectious disease (163 deaths, 9%), cancer (126 deaths, 7%) and suicide (93 deaths, 5%). Of the 1827 deaths, after excluding accidental deaths (89 deaths), 309 deaths (17%) met criteria for SCD. Cardiovascular disease was the underlying causes in the majority of the SCD events (231/309 (75%)). On multivariate analyses, previous MI/CAD (p <0.001, OR 14.25), hypertension (p <0.001, OR 1.84), and age groups between 40-60 yrs (p=0.029) were significantly associated with SCD. Conclusions: Sudden cardiac death accounted for up to half of the cardiovascular deaths in rural Southern India. Traditional cardiovascular risk factors were strongly associated with SCD.

    Original languageEnglish
    Pages (from-to)93-102
    Number of pages10
    JournalIndian Pacing and Electrophysiology Journal
    Volume11
    Issue number4
    Publication statusPublished - Jul 2011

    Keywords

    • Andhra Pradesh
    • Epidemiology
    • Rural South India
    • Sudden cardiac death

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    Madhavan, S., Reddy, S., Panuganti, P., Joshi, R., Mallidi, J., Raju, K., Iyengar, S., Reddy, K., Patel, A., Neal, B., Calambur, N., & Tandri, H. (2011). Epidemiology of sudden cardiac death in rural South India - insights from the Andhra Pradesh rural health initiative. Indian Pacing and Electrophysiology Journal, 11(4), 93-102.