Introduction
Out-of-hospital cardiac arrest is a leading cause of death among adults
in the United States.1 Even though the risk of sudden
cardiac death (SCD) is higher in patients with heart failure (HF) and
coronary artery disease (CAD), the majority of SCD cases occur in the
general population who have cardiovascular (CV) risk factors and no
known heart disease or no symptoms of heart disease.23Given the perennial low rate of successful resuscitation from
out-of-hospital cardiac arrest, prevention of SCD must be the key
approach. This requires good risk stratification to identify a high-risk
group that might benefit from some prophylactic intervention. Yet, in
the general population without symptoms or known heart disease, in which
the majority of SCDs occur, the ACC/AHA/USPTF do not recommend CV
testing.4
Population health can identify patients at risk of CV events. Recently,
a race-based SCD score was derived from the Atherosclerosis Risk in
Communities (ARIC) study 7 and uses commonly collected
variables from the clinical encounter. Using the electronic health
record (EHR) we can calculate risk scores to identify substantial
subpopulations at risk of SCD – estimated to be 4-7% at 10 years in
the highest decile. While this risk is substantial, further cardiac
testing may be able to further refine this risk and identify potential
targets for treatment. The aim of this study was to evaluate the
frequency of CV testing that occurs in patients at different risk
profiles of the SCD score.