Circulation, Vol 65, 457-464, Copyright © 1982 by American Heart Association
LE Hinkle Jr and HT Thaler
One hundred forty-two deaths among 743 men ages 50 - 65 years who had been
examined and followed 5 - 10 years were investigated and classified on the
basis of clinical information from medical and non- medical observers, ECGs
and autopsies. A classification based on the condition of the circulation
immediately before death appears to be most relevant to studies of sudden
death. In 58% of the cases, the subjects collapsed abruptly and his pulse
ceased without prior circulatory collapse (arrhythmic death); in 42%, the
pulse ceased only after the peripheral circulation had collapsed (deaths in
circulatory failure). Thirty-three percent of arrhythmic deaths and 10% of
deaths in circulatory failure occurred in a setting of clinical evidence of
acute ischemic heart disease (p less than 0.005). Forty-five percent of
arrhythmic deaths were preceded by chronic congestive heart failure without
circulatory collapse. Ninety-three percent of final illnesses that lasted
less than 1 hour ended in arrhythmic deaths; 74% lasted more than 1 day
ended in deaths in circulatory failure (p less than 0.001). Eighty-eight
percent of deaths that occurred outside of the hospital were arrhythmic;
71% of deaths that occurred in the hospital were deaths in circulatory
failure (p less than 0.001). Ninety percent of deaths in which the primary
cause of the final illness was heart disease were arrhythmic; 86% of deaths
in which the primary cause was other than heart disease were deaths in
circulatory failure (p less than 0.001). Ninety-one percent of deaths
precipitated by an acute cardiac event were arrhythmic; 98% precipitated by
acute respiratory obstruction, hemorrhage, infection, stroke or other
noncardiac events were deaths in circulatory failure (p less than 0.001).
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Clinical classification of cardiac deaths
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