Sudden cardiac death has long been one of the leading causes of death in the United States. Encouragingly, the number of deaths steadily declined for almost two decades, thanks to advances in emergency medical response, greater awareness of heart disease and prevention strategies.
However, a new analysis of the CDC WONDER database by Bhagwan et al. revealed a sharp reversal beginning in 2018, with sudden cardiac deaths rising by nearly 7% annually. Women experienced a sharper increase than men, with female deaths climbing more than 7.6% per year in the last two years of the study. By race and ethnicity, Hispanics recorded the steepest rise (over 13% per year after 2018), followed by Asian and Pacific Islanders (about 12% per year). Black Americans saw an early rise in the 2000s, followed by a long decline, but rates jumped again after 2018. White Americans showed a similar pattern, with steady declines until 2018 and a subsequent increase of more than 5% per year. In contrast, American Indian and Alaska Native populations were the only group to demonstrate a consistent decline across the entire 20-year period.
Geography also played a significant role. Residents of large metropolitan areas experienced a greater spike in deaths compared to those in rural areas. Regionally, the western United States had the sharpest rise after 2018, surpassing the South and Midwest, which historically carried the highest burden of heart-related deaths. Factors such as extreme heat, higher obesity rates in cities, and stress related to the pandemic may have contributed to this trend. In metropolitan areas, death rates had been falling steadily from 1999 to 2018, but then jumped sharply between 2018 and 2020. In rural areas, rates declined over most of the study period and increased only modestly after 2018.
Several factors likely contribute to this surge. The growing obesity epidemic, now affecting more than one in three adults in 23 states, increases the risk of heart disease and sudden death. Long-standing inequities in healthcare access, particularly for women and minority groups, combined with the underrepresentation of women in clinical trials and lack of gender-specific treatment data, have further left many populations vulnerable.
Although the long-term decline shows that progress is possible, the sharp rise since 2018 is alarming. These trends highlight the urgent need to understand the underlying causes and implement effective prevention strategies. Addressing obesity, improving access to emergency care, and closing treatment gaps for women and minority populations are critical steps to reduce sudden cardiac deaths.
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SOURCE: Clinical Cardiology
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Summarized by: Sneha Annie Sebastian, MD
Department of Internal Medicine, Augusta Health, Fishersville, VA, USA