Sudden cardiac arrest mortality in China: temporal trends and risk factors

TL;DR

This study examines sudden cardiac arrest trends in China from 2013 to 2021, finding rising mortality rates and highlighting regional and demographic risk factors.

Contribution

The study provides the first national and regional estimates of SCD incidence and risk factors in China using comprehensive mortality data.

Findings

Sudden cardiac arrest mortality rates in China nearly doubled from 2013 to 2021.

Males and the elderly are at higher risk, with ischemic heart disease as a major underlying cause.

Most sudden cardiac deaths occur outside hospitals, and prevention measures in China lag behind developed countries.

Abstract

Sudden cardiac death (SCD) accounts for more than half of all sudden death cases, posing a significant health burden in China. However, epidemiological data on SCD are scarce due to the lack of a central data registry and the heterogeneity of case definitions. This study aims to provide reliable estimates of the incidence and risk factors of SCD in China at the national and regional levels from 2013 to 2021, as well as the current status of prevention.

The multi-cause mortality data from 2013 to 2021 were obtained from the National Mortality Surveillance System of China. Deaths related to cardiac arrest were identified. Crude and age-standardized mortality rates were calculated by time, and region. Joint point regression was applied to identify significant changes during the study period. Subgroup analyses and multilevel negative binomial analysis were performed to understand the SCD risk factors. The first-line prevention measures and their current implementation in China and developed countries were also determined from published articles.

From 2013 to 2021, the crude mortality rate of sudden cardiac arrest increased markedly from 8.36 deaths per 100,000 population in 2013 to 18.59 deaths per 100,000 population in 2021. There were considerable differences among regions. Subgroup analysis and negative binomial regression results indicated that males and the elderly were at higher risk of SCD. SCD may be associated with poor medical conditions. More than half of SCDs occurred outside hospitals, and approximately 60% of SCDs were related to ischemic heart disease as the underlying cause. Currently, developed countries have widely adopted primary prevention and emergency treatment measures; however, the utilization rate of such measures in China is relatively low and should be improved.

With the continuous rise in the prevalence of cardiovascular diseases and their related risk factors in China, the burden of SCD is expected to increase. In addition to strengthening the clinical pathways for sudden cardiac arrest cases in pre-hospital and hospital settings, it is also necessary to enhance public awareness, knowledge and first-line practical training through large-scale policies for governmental and community-based projects.

The online version contains supplementary material available at 10.1186/s40779-025-00639-7.

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