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.