BACKGROUND We assessed patterns of health care utilization to further characterize chronic comorbidities prior to sudden death. METHOD From March 1, 2013, through February 28, 2015, all out-of-hospital deaths aged 18-64 reported by emergency medical services in Wake County, North Carolina, were screened to adjudicate 399 sudden death victims. Retrospective analysis of clinical records on victims determined health care utilization. Health care utilization frequency was assessed by latent growth curve analysis. RESULTS Medical records were available for 264 victims (aged 53.5 ± 9.2) who were predominantly male (65%) and white (64%). Of these, 210 (80%) victims had at least one visit within two years of death and 73 (28%) had a visit within one month of death. Over the two years prior to death, there was an increasing frequency of doctor visits (P < .001). Victims averaged 3.7 ± 4.6 yearly visits and were categorized into low (0.4 visits/year), medium (3.3 visits/year), and high (11.4 visits/year) tiers of visit frequency. The high visit tier had a greater prevalence of coronary artery disease (38%), hypertension (80%), diabetes (58%), depression (74%), anxiety (64%), and substance misuse (46%) (P < .001). LIMITATIONS Those who were non-free-living, minors, without formal medical records, and adults aged 65 and older were excluded from the analysis. CONCLUSIONS A majority of sudden death victims utilized health care within two years prior to death and had comorbidities that may have contributed to their unexpected death. The increasing frequency of visits prior to death provided an opportunity for health care providers to address potential victims' chronic medical conditions to potentially prevent death.

BACKGROUND:Sudden death accounts for up to 15% of all deaths among working age adults. A better understanding of victims' medical care and symptoms reported at their last medical encounter may identify opportunities for interventions to prevent sudden deaths.METHODS:From 2013-15, all out-of-hospital deaths, ages 18-64 reported by Emergency Medical Services (EMS) in Wake County, North Carolina were screened and adjudicated to identify 399 victims of sudden death, 264 of whom had available medical records. Demographic and clinical characteristics and prescribed medications were compared between victims with versus without a medical encounter within one month preceding death with chi-square tests and t-tests, as appropriate. Symptoms reported in medical encounters within one month preceding death were analyzed.RESULTS:Among the 264 victims with available medical records, 73 (27.7%) had at least one encounter within a month preceding death. These victims were older and more likely to have multiple chronic illnesses, yet most were not prescribed evidence-based medicines. Of these 73 victims, 30 (41.1%) reported cardiac symptoms including dyspnea, edema, and chest pain.CONCLUSIONS:Many victims seek medical care and report cardiac symptoms in the month prior to sudden death. However, medications that might prevent sudden death are under prescribed. These findings suggest that there are opportunities for intervention to prevent sudden death.

Patients with hypertension (HTN) have increased risk of sudden death, but blood pressure control in sudden death is not clear. To better understand potential opportunities to prevent sudden death, we assessed blood pressures, comorbidities and control among all cause sudden death victims. Cases of

Introduction: Despite significant reduction in cardiovascular mortality, the incidence of sudden unexpected death (SUD) has not decreased substantially. Risk management by doctors and community health workers has the potential to reduce SUD in rural communities. We performed a qualitative assessment to understand behavioral constructs that might aid their efforts. Methods: The archives of the Southern Oral History Program (SOHP) contain about 6000 interviews. Using keywords related to SUD prevention, we selected 171 interviews. Stratified purposeful sampling identified information-rich cases from rural areas. We coded transcripts based on both predetermined and emerging codes and wrote memos for each transcript. A final code report synthesized information from these memos into themes. Results: We assessed 23 interviews with people of diverse ethnicities (42% African-Americans) who were mainly farmers (46%) or textile workers (29%). Four themes emerged from the interviews: "sense of surrender", "social support", "instrumental doctor-patient relationship" and "lack of proactivity". (Table 1) The "sense of surrender" emerged when people talked about the heightened period of symptoms, often characterized by limited health knowledge and preparation. "Social support" among neighbors and family was strong and evident during hardship. The "instrumental doctor-patient relationship" highlights a shift to one-way communication of absolute diagnoses and recommendations. The "lack of proactivity" emerged when people did not take ownership of their health to modify risk factors and waited for serious conditions before seeking medical help Conclusion: We found that even individuals showing proactivity in work and home life often have a sense of surrender in their relation to their health. Our findings can guide interventions on how doctors and community health workers can promote partnerships for prevention of sudden unexpected death in rural communities.