Sudden death is increasing in Europe. Between 2010 and 2020, almost 2.6 million deaths from this cause were recorded on the continent, showing an upward trend of 2.9% annually. The increase is especially notable in Spain, which, with an average annual increase of 3.3%, is the country analyzed with the highest increase. Overall, mortality has increased by approximately 30% over the last decade. These are the conclusions of a study published in the scientific journal Lancet Regional Health. “The novelty of our work lies in offering the most complete and up-to-date overview of these trends across Europe,” explains Marco Zuin, a cardiologist at Ferrara Hospital, Italy, and lead author of the study, in an exchange of messages. “This has allowed us to highlight important differences by sex and geographical region that had not been sufficiently recognized.”
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The study weighed the total burden of these types of deaths, which represent almost 5% of all deaths on the continent. It was based on World Health Organization mortality data covering 26 European countries and over 53 million deaths. “This ensures international consistency and comparability,” explains Juan Jiménez Jáimez, head of the Arrhythmias and Hereditary Cardiomyopathies section at Hospital Universitario Virgen de las Nieves, in statements to the scientific portal SMC. “Its design, based on age-adjusted rates and trend regression models, allows for a robust description of the temporal evolution of sudden death mortality.”
Sudden death can be defined as that which occurs within the first hour from the onset of certain symptoms or as the unexpected death of an apparently healthy person who was well in the previous 24 hours. Many consider it the most devastating form of death due to its unexpected nature.
Most sudden deaths occur in men, but this proportion could change, as in recent years, according to the present study, there has been a significantly greater increase in women. The study did not analyze the underlying causes. “This increase in women may reflect several factors, including a higher burden of cardiovascular risk factors, differences in symptoms leading to delayed diagnosis, and disparities in access to timely care and resuscitation,” explains Zuin. These findings highlight the need for greater attention to cardiovascular risk in women.
The causes of sudden death are varied, but the vast majority, around 80%, are cardiovascular events: myocardial infarctions, cerebral hemorrhages, etc. Therefore, it is very important to control risk factors: reduce the incidence of obesity, diabetes, and hypertension. Zuin points to these conditions as possible factors explaining the increase in sudden deaths. His study does not analyze the underlying causes, but the expert also points to population aging, differences in access to healthcare, and improvements in death certification, in addition to those mentioned.
Not all countries analyzed showed an increase in sudden death cases. Austria and Belgium, for example, showed the largest reduction in these types of events, with rates of -8.0% and -7.9%, respectively. This contrasts with the increase in Spain and Germany (+3.3% and +2.8%, respectively), which are at the bottom of the list. “In the case of Spain, it probably responds to a multifactorial interaction,” explains Jiménez Jáimez, who highlights, above any other factor, population aging. “[Spain] is the country with the highest life expectancy in Europe and the world, which implies a higher proportion of the population in high-risk age groups.” It is more frequent after 40 or 50 years of age, as it is from these ages that the risk of developing a cardiovascular problem begins to increase. It is estimated that, from the age of 50, the risk can grow up to 10% annually. However, below 40 years of age, the risk is estimated at around 0.1% annually. Sudden infant death, despite having a similar name, is a different and much less understood problem.
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Added to this is a change in lifestyles. The worsening of diet and a more sedentary routine have resulted in an obesogenic world. There are too many people who are too fat. In the last 30 years, the number of overweight people doubled globally, reaching unprecedented figures: in 2021, there were more than 2.11 billion adults and 493 million young people and children who were overweight or obese. “This is especially true for women, with greater sedentarism and an increase in cardiovascular risk factors (obesity, diabetes, hypertension), which may contribute to the sharper increase observed in this subgroup,” notes the expert.
Sudden death has been the leading cause of death in Western countries for decades. The situation began to improve slightly in the 1970s; the reduction in smoking, new medications for hypertension and cholesterol, and the popularization of interventions such as the implantation of stents and bypass surgery contributed to a significant decrease in mortality over several decades. However, it seems evident that in 2010 there was a new turning point. The increase in obesity and type 2 diabetes may be behind this change in trend, but not only.
A recent study by the University of Messina also warned of the “dramatic increase” in heart-related sudden deaths and the “alarmingly low survival rate.” The study emphasized the importance of teaching cardiopulmonary resuscitation, as this maneuver, performed by bystanders, is the determining factor in saving victims of out-of-hospital cardiac arrests. Globally, the average percentage of non-medically trained people capable of CPR is 40%, but in high-income countries, the average rate is double that in upper-middle-income countries (50% versus 23%). This type of training in schools and centers for the elderly could make a big difference, they argue. It is an idea to consider. There is a percentage of these types of deaths that are impossible to prevent. But it has already been shown in the past that the trend can be reversed. It is a matter of will.
“Our results highlight that sudden death remains a serious public health problem in Europe,” explains Zuin. “Addressing this challenge will require multidisciplinary strategies, better prevention, increased public awareness, and more robust emergency response systems.”
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