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Sudden cardiac death
- 1. Public Health Englandhosts the UK National Screening Committee Sudden Cardiac Death Screening in 12 to 39 year olds Dr Sunil Bhanot
- 2. Definition Sudden Cardiac Death •Death (unexpected sudden cardiac arrest) occurring within one hour of the onset of symptoms in a young person without a previously recognised cardiovascular abnormality • It is usually precipitated by physical activity • Causes • Structural: Hypertrophic Cardiomyopathy • Electrical abnormalities: Arrhythmia • External causes: Blunt chest injury 2 Sudden Cardiac Death Screening in 12 to 39 year olds
- 3. Commissioning • 2008 UKNSC recommended against Hypertrophic Cardiomyopathy screening • Rationale: Accuracy of testing • High False Positives and False Negatives • 2013 Present review commissioned • Undertaken by Phil Wiffen (Oxford Systematic Review Services) and Mike Clarke (University of Belfast) • Wider scope exploring broad range of conditions associated with Sudden Cardiac Death in young people 3 Sudden Cardiac Death Screening in 12 to 39 year olds
- 4. Document Development • Literaturesearch • All research on Sudden Cardiac Death between 1974 and end of 2013 • Primary question • Impact of screening in reducing incidence of Sudden Cardiac Death in 12 to 39 year olds • Secondary questions • Availability of screening tests and their accuracy • National screening practices • Evidence of benefits and harms 4 Sudden Cardiac Death Screening in 12 to 39 year olds
- 5. Review Findings • Importanthealth issue but uncertainty over incidence • Poorly understood conditions that lead to Sudden Cardiac Death • No high quality evidence to guide clinicians advising patients on management, treatment and lifestyle • Test performance: No studies reporting on sensitivity and specificity. • Little screening programme evidence • Literature mostly on screening in young people participating in sport • Screening evidence is not peer reviewed or has been questioned • No direct evidence that screening reduces incidence of Sudden Cardiac Death 5 Sudden Cardiac Death Screening in 12 to 39 year olds
- 6. Consultation • 3 monthConsultation opened in November 2014 • Responses from: • 3 families affected by Sudden Cardiac Death • Personal submission from National Clinical Director for Heart Disease • British Cardiovascular Society • Royal College of Paediatrics and Child Health • Cardiac Risk in the Young (CRY) • Consultation responses acknowledged limited evidence around: • effect of screening on preventing Sudden Cardiac Death • management of people with risk factors • Uncertainty of current strategy • Not all stakeholders agreed with the recommendation 6 Sudden Cardiac Death Screening in 12 to 39 year olds
- 7. UK National ScreeningCommittee • Further literature consideration sent in as part of consultation comments was considered by the external reviewers and final recommendation brought to the UK NSC in May 2015. • Recommendation • The UK NSC does not recommend a systematic population screening programme for Sudden Cardiac Death. • There are serious limitations in the literature on fundamental issues relating to the condition, test, intervention and cost-effectiveness of a screening programme. 7 Sudden Cardiac Death Screening in 12 to 39 year olds
- 8. Recent News andStudies • Van Brabandt et al. 2016 Harms and Benefits of Screening Young People to Prevents Sudden Cardiac Death. • 2016 National Collegiate Athletic Association (USA) consensus guidelines • American College of Cardiology and American Heart Association do not recommend routine, large scale ECGs. • Recommend taking family history and physical examination. 8 Sudden Cardiac Death Screening in 12 to 39 year olds
- 9. What Might ScreeningLook Like?... Van Brabandt et al. 2016 Belgium Study 9 Sudden Cardiac Death Screening in 12 to 39 year olds Infographic reproduced, with permission, from Van Brabandt et al. 2016 HTA study of potential SCD screening in Belgium
- 10. References 1. https://legacyscreening.phe.org.uk/suddencardiacdeath 2. VanBrabandt et al. 2016 , H. Desomer, A. Gerkens S. and Neyt, M (2016) Harms and Benefits of Screening Young People to Prevents Sudden Cardiac Death, BMJ, 2016;353:i1158 3. Infographic reproduced from Van Brabandt et al. 2016 https://kce.fgov.be/sites/default/files/page_documents/KCE_241Cs_sportscr eening_Synthesis_0.pdf 10 Sudden Cardiac Death Screening in 12 to 39 year olds