{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T17:46:38Z","timestamp":1778003198883,"version":"3.51.4"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,1,22]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              It is believed that most sudden cardiac arrests (\n              <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\n              s) in young people occur in previously healthy people with rare risk factors for sudden death. Few studies have investigated large populations with complete ascertainment. Our objective was to use multisource records to identify and classify all out\u2010of\u2010hospital cardiac arrests in the Greater Toronto Area (population 6.6\u00a0million) in people aged 2 to 45 years from 2009 to 2012.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Expert reviewers employed a systematic process, with emergency medical services, in\u2010hospital and coroner records, to adjudicate the cause of death as\n              <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\n              from cardiac or noncardiac causes. We report the adjudicated etiologies, circumstances, triggers, and characteristics of the\n              <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\n              cohort. Of 2937 eligible\n              <jats:styled-content style=\"fixed-case\">out\u2010of\u2010hospital cardiac arrest<\/jats:styled-content>\n              cases, 608 (20.7%)\n              <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\n              s had an adjudicated etiology of cardiac cause (120 survivors and 488 nonsurvivors). Two thirds of these\n              <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\n              patients had a history of cardiovascular disease, and over 50% had been diagnosed with \u22651 cardiovascular disease risk factor. Moreover, 20.1% of\n              <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\n              s were diagnosed with psychiatric disease and 30% had central nervous system drugs prescribed. Over 30% of\n              <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\n              patients had\n              <jats:styled-content style=\"fixed-case\">central nervous system<\/jats:styled-content>\n              active drugs, including drugs of abuse detected postmortem, with opioids and ethanol being detected most frequently. Potentially heritable structural cardiac diseases accounted for only 6.9% of\n              <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\n              events, with acquired cardiac diseases comprising the rest.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The underlying causes of\n              <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\n              , in people aged 2 to 45 years, often occur in those with previously diagnosed cardiovascular diseases, and are associated with contributory factors including prescribed medications, recreational drugs, and a concomitant psychiatric history.\n            <\/jats:p>\n          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