Risk Factors for Sudden Cardiac Death Among Patients with Alcohol Dependence: A Nested Case–Control Study

Background Excessive alcohol consumption causes a broad range of health problems, including premature mortality and sudden cardiac death ( SCD ). We identified potential clinical characteristics and laboratory indices associated with SCD among patients with alcohol dependence. Methods Patients with alcohol dependence ( n  = 2,793) admitted to a psychiatric center in northern Taiwan between 1985 and 2008 were linked with a national mortality database for causes of death. Of the 2,793 patients in the cohort, 67 cases died of SCD . The standardized mortality ratio ( SMR ) of SCD relative to the general population was calculated. Based on a nested case–control design, we selected a set of sex‐, age‐, and year‐of‐admission‐matched two control subjects for each case derived from the cohort. We collated the clinical information through a standardized review of patients' medical records. Conditional logistic regressions were then conducted to explore potential exposures associated with SCD . Results The sample had substantially higher SCD mortality ( SMR 12.8) compared to the general population. After adjustments in the multivariate analyses for the clinical profiles at the index (earliest) admission, both abnormal electrocardiography ( ECG ) (adjusted risk ratio = 16.97, 95% confidence interval ( CI ) 1.60 to 179.58, p  = 0.019) and elevated aspartate aminotransferase levels ( adjusted risk ratio  = 1.01, 95% CI 1.00 to 1.02, p  = 0.046) were significantly associated with SCD. Conclusions This study raises the question of whether intensive follow‐up of patients with elevated AST and abnormal ECG findings should be evaluated as a strategy to prevent SCD in patients with alcohol dependence.