36 JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA • VOL 62 • DECEMBER, 2014 1 Grant Medical College and Sir J.J. Group of Hospitals, Mumbai; 2 KJ Somaiya Medical College and Research Centre, Mumbai; 3 Manager-Research and Reports, Quintiles Cardiac Safety Services, Mumbai; 4 Consultant Cardiologist, Arrhythmia Associates, Mumbai Received: 07.05.2014; Accepted: 26.05.2014 Introduction S udden death is defined as natural death, in which the time and mode of death is unexpected, in an individual with or without pre-existing cardiac diseases, and which occurs within 1 hr of the onset of the heralding symptoms. 1 This definition is often usable as a combination of the various definitions of sudden death, which vary according to clinical, scientific and medico-legal requirements. In the vast majority of the cases, the eventual cause of sudden death has been attributed to cardiac causes and several studies have used the terms ‘sudden death’ and ‘sudden cardiac death’ (SCD) synonymously. 2 The recent estimates of SCD in the United States range from 184,000-462,000 deaths annually, with the incidence of SCD ranging from 60 to 151 per 100,000 inhabitants per year in the United States. SCD also accounts for more than 60% of all cardiac deaths. 3,4 The studies conducted in the decade prior to this have also shown comparable estimates, considering the varying methods of assessment such as death certificates, autopsies, hospital records, questionnaires and direct interview of relatives. The figures from these studies suggest an overall incidence between one and two deaths per 1000 persons among the general population, with the incidence increasing to more than 20 times in patients with severe cardiovascular diseases. 5 In the studies evaluating the causes of SCD, the most common underlying substrate has been coronary artery disease (CAD), followed by arrhythmias. 6 Most of these studies were from North America and Western Europe; the estimates have significantly influenced their health care systems in establishing systematic diagnostic measures for early risk stratification of cardiovascular conditions. In India, we do not have a national registry for sudden death. 2 Very few countries in the Asia- Pacific region have conducted studies evaluating the occurrence of SCD using systematic methods of assessment. This lag in setting up adequate risk stratification measures has thwarted the significant advancements made by India in emergency critical care management. We, therefore, reviewed recent published data on SCD for its causes, risk factors Sudden Cardiac Death in India : A Growing Concern Bianca S Honnekeri 1 , Disha Lokhandwala 2 , Gopi Krishna Panicker 3 , Yash Lokhandwala 4 review article Abstract The incidence of sudden cardiac death (SCD) is based on studies from North America and Western Europe with very few countries in Asia having conducted robust studies evaluating the occurrence of SCD. This paper reviewed published data on SCD, with a focus on India. In recent years, varying methods of assessment such as verbal autopsies, questionnaires, and quantification of surrogate endpoints such as cardiovascular disease profiles have been used to estimate the incidence of SCD. These studies have shown that the incidence of SCD is on the rise, especially in the urban regions, which may be largely attributed to the increase in prevalence of coronary artery disease, diabetes and hypertension in India. These studies have shown that the risk stratification and management approach for SCD are conspicuously varied and there is a need for establishing a systematic approach for estimating the incidence and risk factors of SCD in India.