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Canadian Journal of Cardiology

Understanding Etiologies of Cardiac Arrest: Seeking Definitional Clarity

Published:August 16, 2022DOI:https://doi.org/10.1016/j.cjca.2022.08.005

      Abstract

      Cardiac arrest leading to death and sudden cardiac death (SCD) may refer implicitly to situations in which death is unexpected and primarily of cardiac cause. National and international societies have published differing definitions for the various terms relating to cardiac arrest and SCD. We highlight the controversies in defining SCD, including the lack of a universal definition, the heterogeneity in the operationalization of the term “sudden,” and limitations of time-based systems of SCD classification. We discuss the importance of a standardized methodology for classifying cardiac arrest as recommended by the World Health Organization (WHO) that should include use of multisource evidence (eg, coroner, autopsy, and toxicology reports) for confirming or refuting a cardiac cause of arrest. We reveal how a universal definition of SCD has been incorrectly attributed to the WHO and how this has been perpetuated in the literature. We make the case that definitional clarity is essential to understanding epidemiology, evaluating novel treatments, forming international collaboration, and innovating public health prevention strategies. We propose a practical schema to categorize cardiac arrest events to describe and study this population more accurately.

      Résumé

      L’arrêt cardiaque menant au décès et la mort cardiaque subite (MCS) peuvent implicitement faire référence à des situations dans lesquelles le décès est inattendu et de cause principalement cardiaque. Les sociétés nationales et internationales ont publié différentes définitions de termes variés liés à l’arrêt cardiaque et à la MCS. Nous abordons dans cet article la controverse liée à la définition de la MCS, notamment l’absence de définition universelle, l’hétérogénéité dans la mise en application du terme « subite » et les désavantages des systèmes de classification de la MCS fondés sur le temps. Nous nous penchons également sur l’importance d’une méthodologie normalisée pour classer les arrêts cardiaques, comme le recommande l’Organisation mondiale de la Santé (OMS), qui devrait inclure l’utilisation de données probantes provenant de différentes sources (coroners, autopsies et rapports de toxicologie) pour confirmer ou infirmer la cause cardiaque d’un arrêt. Nous expliquons comment une définition universelle de la MCS a été incorrectement attribuée à l’OMS, puis réutilisée dans la documentation médicale. Nous soutenons qu’une définition claire est essentielle pour comprendre l’épidémiologie, évaluer les nouveaux traitements, établir des collaborations internationales et innover sur le plan des stratégies de prévention en santé publique. Nous proposons un schéma pratique pour catégoriser les arrêts cardiaques afin de décrire et d’étudier cette population avec moins d’ambiguïté.
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