Sudden Death: New AIIMS-ICMR Study Highlights Underlying Heart Problems Behind Rising Young Adult Deaths

 

Sudden death among young adults is emerging as a major public health concern. A recent study from AIIMS, New Delhi and ICMR, published in the Indian Journal of Medical Research, has found that more than half of all sudden death cases occurred in people aged 18-45 years, with men being disproportionately affected. Most deaths were linked to undetected cardiovascular conditions, including congenital heart defects and structural cardiomyopathies. The study, which analysed 180 sudden death cases from over 2,200 autopsies, underscores that sudden death can strike even apparently healthy individuals, highlighting the critical need for early detection and preventive care.

What Is 'Sudden Death'?

 

According to the report, 'sudden death' is defined as 'a death that occurs within one hour of onset of symptoms in witnessed cases and/or within 24 hours of last being seen alive in unwitnessed cases'. It is one of the major public health concerns noted in all age groups, and across gender, socio-economic strata and ethnic categories.

Despite major advancements in healthcare, sudden death remains a significant public health burden, with substantial mortality. Commonly, sudden deaths are noted in the extremes of age groups: Infants and elderly. However, sudden death is relatively rare among individuals under 45 years of age, with an estimated global incidence ranging from 0.8 to 6.2 per 1,00,000 persons per year. It is often the first manifestation of an underlying disease in a previously asymptomatic and apparently healthy individual.

 

The incidence of sudden death in relatively young adults appears to be increasingly seen as a public health concern, with a broad spectrum of diseases involving cardiac (accounting for 2/3rds) and non-cardiac (accounting for 1/3rd) of all cases.

 

The aetiology (causes, or manner of causation of a disease or condition) of sudden death in young adults differs substantially from that in the elderly, with a higher prevalence of arrhythmogenic disorders (inherited heart muscle diseases), structural cardiomyopathies (heart muscle disorders) and congenital anomalies. Hence, it is of paramount importance to identify the various causes and aetiological factors leading to sudden death for future health programmes and prevention strategies, the report suggested.

 

What's New In The AIIMS Study?

The cross-sectional study was conducted at the Department of Pathology and Forensic Medicine, All India Institute of Medical Sciences, New Delhi, from May 2023 to April 2024. All procedures followed were in accordance with the Helsinki Declaration of 1975, as revised in the year 2000, and carried out after the approval and guidelines of the Institute Ethics Committee.

 

All sudden death cases brought to the forensic mortuary, meeting the definition criteria of sudden death, were included in this study. Accidents, poisoning, history of drug abuse, homicide, suicide and cases with prior severe medical illness were excluded from this study. The cases were categorised according to their age groups, as sudden death in young (18-45 years), and sudden death in old (46-65 years).

Verbal autopsy, which involved interaction with close relatives and friends of the deceased regarding the circumstances of the death, previous medical history (including Covid disease and vaccination), drug abuse, smoking and alcohol habits, were noted in a standard proforma with proper informed consent. All autopsies were conducted within 48 hours of death.

 

Findings Of The Study

A total of 2,214 cases were received at the forensic mortuary during the study period. Of these, the numbers meeting the criteria of sudden death were 180 (8.1 per cent), from which, 18 were excluded due to extensive autolytic changes, leaving 162 as the study cohort. Among the total number of sudden deaths, those in young (18-45 years) accounted for 94 deaths (58 per cent), which was 4.7 per cent of the total autopsied cases (2,214), while those among the old (46-65 years) accounted for 68 deaths (42 per cent).

The average age of sudden death cases among young adults was 33.6 years, with men outnumbering women by more than four to one. Most deaths occurred in people in their 30s, followed by those in their 20s and early 40s. Among older individuals, the average age was 53.8 years, with an even stronger (16:1) male predominance.

 

Patterns in Sudden Death Cases

Most sudden death cases were reported from the Delhi-NCR region, accounting for nearly 72 per cent of the total, with the remaining cases coming from neighbouring Haryana and Punjab. A large majority of the deceased belonged to lower- and middle- socioeconomic groups. The individuals were engaged in a wide range of occupations, including skilled and unskilled work, while about a fifth were unemployed.

 

Sudden deaths occurred throughout the year, with the highest numbers in autumn (32 per cent) and winter (28 per cent). Most deaths happened at night or early morning (40 per cent), followed by morning hours (30 per cent) and were slightly more common mid-week, particularly on Wednesday and Thursday. Over half the cases (55 per cent) occurred at home, while 30 per cent happened during travel, and 15 per cent at the workplace or outdoors.

The most commonly reported symptom before death was sudden loss of consciousness (36 per cent), followed by chest pain (20 per cent), gastrointestinal issues like abdominal pain and vomiting (19 per cent), shortness of breath (11 per cent), uneasiness (8 per cent) and fever (6 per cent).

 

Comorbidities were relatively uncommon in younger individuals, with a few cases of diabetes (3 per cent), hypertension (5 per cent), tuberculosis, and epilepsy. In older adults, comorbid conditions were more frequent, including diabetes (12 per cent), hypertension (19 per cent), tuberculosis, asthma and a few with prior surgeries, such as joint replacement or cataract operations, revealed the report.

 

Reason Of Death

In older adults (46–65 years), coronary artery disease (CAD) was the leading cause of sudden death, accounting for 72 per cent of cases, followed by sudden unexplained deaths (14 per cent), gastrointestinal causes (7 per cent) and pulmonary causes (4 per cent).