Opportunities to prevent sudden out-of-hospital death due to coronary heart disease in a community.

Abstract

Intervening successfully to reduce the burden of sudden out-of-hospital death due to coronary heart disease (OHCD) requires knowledge of where these deaths occur and whether they are observed by bystanders. To establish the proportion of OHCDs that were witnessed and where they occurred, we reviewed the coroner's notes and medical records of a previously-described sample of OHCD cases among residents of Olmsted County, Minnesota. This cohort (n=113) consisted of a 10% random sample of all Olmsted County residents who died out-of-hospital between 1981 and 1994 and whose deaths were attributed to coronary heart disease. Excluding deaths in nursing homes (n=27), 71 (83%) of the deaths occurred in private homes and 15 (17%) occurred in public places. The event was not witnessed in 59% of deaths occurring in private homes and in 20% of deaths occurring in public places. The presence or absence of a bystander could not be established for 10% of deaths in private homes and 7% of deaths in public areas. A significant proportion of OHCDs occur in private homes and are not witnessed. Prevention of unwitnessed deaths will require programs that result in primary prevention and/or calls to first responders at the time of impending cardiac arrest.