P1073Epidemiology of sudden cardiac death in sub-saharan africa: a population-based cohort survey in cameroon

Abstract

Background- The rate of cardiovascular (CV) risk factors is on the rise in sub- Saharan Africa (SSA), thereby sowing the seeds for the sprawling dissemination of premature cardiac death in this burgeoning African population of patients with CV morbidities. Although being reported, incidence estimates of sudden cardiac death (SCD) in SSA are unknown. Method- During 12 months, the household administrative office and health community committee within neighborhoods in two health areas of Douala, Cameroon, registered all deaths among 86,188 inhabitants aged > 18 years. As part of an extended multi-source surveillance system, the Emergency Medical Service (EMS), local medical examiners and district hospital mortuaries were also surveyed. Whilst two physicians investigated every natural death, two cardiologists reviewed all unexpected natural deaths. Results- There were 288 all-cause deaths. Twentyseven (9.4 %) were SCD (48.1% women). The crude incidence rate was 31.3 (95 % CI: 20.3 to 40.6)/100 000 person-years. The age-standardized rate by the African standard population was 33.6 (95 % CI: 22.4 to 44.9)/100 000 personyears. The median age of victims was 46 years and the number of SCD in persons aged> 40 years was not greater than those < 40 years. Death occurred at night in 37 % cases, including 11 % of patients who died while asleep. One non-competitive female athlete aged 35 years died while exercising. Out-of hospital sudden cardiac arrest occurred in 63 % of cases, 55.5 % of which occurred at home. Of the 89 % cases of witnessed cardiac arrest, 63 % occurred in the presence of a family member, 21% of cases were found dead (or presumably so) at the scene and brought directly to a mortuary, and 42% of agonal victims were transported by taxi/cab to emergency care centers without any resuscitation attempts and cardiopulmonary resuscitation was attempted only in 3.7 %. Hypertension and diabetes were known to be present in 22.2 % and 11.1 % of victims respectively. One 65-year-old man experienced witnessed chest pain consistent with an acute coronary syndrome before he lost consciousness. Heart failure was diagnosed in 4 (14.8 %) patients. ECG recording was not available in any cases, and 2-D Echo was available in only 2 patients but no data of left ventricular ejection fraction was registered. Conclusion- The burden of SCD in this African population is heavy with distinct characteristics, while awareness of SCD and the need for prompt resuscitation appear suboptimal. Larger epidemiological studies are required to establish the real burden in SSA and implement specific preventive strategies targeting the most vulnerable groups of young people and women.