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The MMWR is embargoed until 12 Noon, ET

February 15, 2002
Contact: Kathryn Harben
CDC, National Center for Chronic Disease Prevention
and Health Promotion
(770) 488–5131

MMWR Press Release

More than 60% of heart disease deaths in 1999 were "sudden" and nearly half happened outside of hospital

Despite advances in the prevention and treatment of heart attacks and improvements in emergency transportation, more than 60% of heart disease deaths in 1999—more than 460,000—were unexpected or "sudden," and nearly half of all heart deaths (46.9%) occurred outside of the hospital, according to an analysis of state data by the Centers for Disease Control and Prevention (CDC).

Of the 728,743 heart disease deaths in 1999, 462,340 (63.4%) were defined as sudden cardiac deaths (SCD). Of those, 46.9% occurred outside of the hospital and 16.5% occurred in the emergency room or were pronounced dead upon arrival at the hospital, according to the latest death certificate data from the National Center for Health Statistics. Women were more likely than men to die before reaching the hospital (51.9% compared to 41.7%).

The states with the highest percentages of SCD were Wisconsin (72.9% of all heart disease deaths), Idaho (72.2%), Utah (72.1%), Colorado (71.3%), and Oregon (71.0%). States with the lowest SCD still had percentages close to 60%: Hawaii (57.2%), Arkansas (57.5%), New Jersey (57.6), Kentucky (58.4%), and Oklahoma (58.5%).

Possible reasons for the high percentages, according to the CDC researchers, are the unexpected nature of SCD and the failure to recognize early warning symptoms of heart disease, particularly heart attack. Early recognition of symptoms can lead to early treatment that results in less heart damage and fewer deaths.

"These high numbers of sudden deaths from heart disease, and the fact that they occur outside of the hospital, are alarming," said CDC Director Jeffrey P. Koplan, MD, MPH. "CDC and its partners are working closely with states to educate Americans—and their health care providers—about the common and uncommon signs of heart attack and to encourage them to dial 9-1-1 immediately.”

Uncommon symptoms of heart attack that the public and health care providers should watch for include breaking out in a cold sweat, nausea, and light-headedness. More common symptoms are chest discomfort or pain; pain or discomfort in one or both arms or in the back, neck, jaw, or stomach; and shortness of breath.

Douglas Zipes, MD, president of the American College of Cardiology, concurred. "Because almost one of every two Americans will die of cardiovascular disease, and because about half of those deaths will be sudden, we need to train people in cardiopulmonary resuscitation and in use of the automated external defibrillator, and make that equipment widely available," Zipes said.

CDC and its partners are working to increase public awareness about the signs and symptoms of a heart attack. The National Heart, Lung and Blood Institute of the National Institutes of Health and the American Heart Association recently launched a new heart attack education campaign called Act in Time to Heart Attack Signs. Information is available at and

"This campaign is the latest example of the strong partnership and complementary efforts of public and private advocates devoted to preventing sudden cardiac deaths and other forms of heart disease in the United States," said David Faxon, MD, president of the American Heart Association.

Cardiovascular diseases–principally heart attack, stroke and high blood pressure – kill nearly a million Americans each year, making it the leading cause of death among men and women and all racial and ethnic groups. About 62 million Americans live with cardiovascular disease, which in 2002 is expected to cost the nation an estimated $329.2 billion in health care expenditures and lost productivity. This burden continues to grow as the population ages.

Besides being aware of the warning signs of heart disease and responding immediately when they occur, people can reduce their chances of disease through lifestyle changes: being physically active, eating a diet low in fat and high in fruits and vegetables, and stopping or never starting smoking.

CDC protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

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