Evaluating the Diagnostic Gap in Risk Stratification for Sudden Cardiac Death

Abstract

Background: Prevention of sudden cardiac death (SCD) has, to date, focused on individuals with advanced heart disease due to the high risk of this population. Yet, the majority of SCD events occur in the general population, in particular those without known heart disease. As cardiovascular testing is generally not recommended in asymptomatic individuals. Our aim was to define the diagnostic gap in the subgroup of a primary care population deemed to be at moderate risk of SCD by a recently developed risk score. Methods: We conducted a cross-sectional study of primary care patients from two large academic institutions and excluded those with coronary artery disease, heart failure, and atrial fibrillation. We calculated the SCD risk score and classified them into low, intermediate and high-risk categories. We evaluated the period prevalence and odds ratio (OR) of echocardiography and stress testing by risk of SCD adjusted for age, gender, race, and ethnicity. Results: We identified 36,885 patients without heart disease from both institutions with a median SCD score of 9% . The period prevalence of having an echocardiogram was 18% for those in the lowest SCD risk and 36% for those in the highest SCD risk group. The percentage of patients who had a stress test was 18% for those in the lowest SCD risk and 23% for those in the highest SCD risk group. The OR of having any test was 1.09 (1.00-1.18) for those in the intermediate risk category and 1.22 (1.09-1.37) for those in the highest risk category compared to those with the lowest risk. Conclusions: In patients identified to be at moderate risk for SCD in a primary care population, cardiovascular testing occurs in only a third. It is possible that more extensive cardiovascular screening of these patients could detect subclinical disease associated with SCD risk.