Scorecard set to provide cardiac death risk breakthrough

A scorecard system developed by scientists in the USA is set to allow health experts to identify those at risk of developing sudden cardiac death.

The condition is an electrical malfunction in the heart that causes it to stop beating.  Researchers in the Smidt Heart Institute at Cedars-Sinai say they are now one step closer to identifying patients at highest risk for developing the condition.

Unlike heart attacks (myocardial infarctions), which are typically caused by clogged coronary arteries reducing blood flow to the heart muscle, sudden cardiac death most often results from the sudden onset of erratic electrical activity that impairs the pumping function of the heart. Patients may have little or no warning, and the disorder usually causes death within minutes if no resuscitation is performed.

To identify those at highest risk, researchers used a polygenic risk score that has been previously shown successful in predicting coronary artery disease. This Cedars-Sinai study, however, is the first study proven to be effective at identifying coronary artery disease patients at highest risk for sudden cardiac death.

The study found that patients with coronary artery disease without severely impaired heart function had the highest polygenic risk score, translating to a 77% increased risk for sudden cardiac death.

“In order to better predict and prevent sudden cardiac death, we must first understand the genetic connection between it and coronary artery disease,” said Roopinder Sandhu, associate professor of Cardiology, and first author of the study. “We found incorporating information from this genetic risk score improved our ability to predict sudden death beyond the contributions of other known risk markers. Most exciting, the genetics were able to identify patients where sudden death was more likely to limit their life expectancy.”

Sudden cardiac death, also called sudden cardiac arrest, accounts for approximately 300,000 deaths each year in the US and is a leading international health problem, responsible for 15% to 20% of all deaths. Coronary artery disease is the most common underlying reason for sudden cardiac death. Sandhu says in the future, this work may help better identify patients who would benefit most from lifesaving therapies like a defibrillator.

At present, most sudden cardiac deaths, 70%, occur in patients who do not meet current guidelines for prevention with defibrillator therapy. Thus, contemporary practice not only neglects most individuals who develop sudden cardiac death but also involves electrophysiologists placing defibrillators in patients with advanced heart disease who are often unlikely to benefit due to limited life expectancy.

Christine Albert, chair of the Department of Cardiology in the Smidt Heart Institute and senior author, added: “This study indicates there is opportunity to identify patients at highest risk for sudden cardiac death, and then offering meaningful, preventative treatment solutions like a defibrillator. Based on our pivotal research, we now have the foundation to achieve this.”

The study found that patients with coronary artery disease without severely impaired heart function had the highest polygenic risk score, translating to a 77% increased risk for sudden cardiac death.

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