ArticleEBioMedicine2026
Prospective use of genomics in the evaluation of sudden cardiac death: results from a national health service population pathway.
Article in EBioMedicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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18 authors.
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Abstract
backgroundSudden cardiac death (SCD) is a major cause of premature and potentially avoidable mortality. Determining whether a SCD was caused by an inherited cardiac condition (ICC) enables identification and appropriate clinical management of at-risk relatives. We report findings from the NHS and Coronial Service Sudden Unexpected Death programme, which established a national pathway aimed at reducing population risk of SCD in England.
methodsCases of SCD were included where a coroner's autopsy raised suspicion of an ICC (ages 1-60) or was unable to determine a cause of death (sudden arrhythmic death syndrome [SADS]) (ages 1-40). Decedent tissue was retained for post-mortem genetic testing, and their relatives were signposted to a new ICC pathway. Where a decedent harboured a pathogenic (P) or likely pathogenic (LP) genetic variant associated with an ICC, relatives were offered predictive genetic testing for that variant. A negative genetic result enabled appropriate discharge, while a positive result triggered clinical evaluation for cardiac disease phenotype. Where no ICC associated P or LP variants were identified in decedents, their relatives underwent clinical evaluation.
findingsOf 107 SCD cases, the most common findings were SADS (35%) and arrhythmogenic cardiomyopathy (15%), while 17% of those tested were found to have P or LP variants. Three-hundred-and-seven relatives subsequently entered the ICC clinic for further evaluation. Diagnostic yield for relatives of decedents with P or LP variants was 47%. Of the 235 relatives who completed ICC evaluation, 28% were provided with a new genetic and/or clinical diagnosis and subsequently managed appropriately. One notable family cluster (n = 24) included 13 individuals (57%) with the KCNH2:c2775dup variant causative of long QT syndrome.
interpretationIntegration of coronial, pathology, genomic, and cardiac services in a prospective population pathway enabled efficient capture and use of genetic and clinical information to reduce population risk of SCD.
fundingBritish Heart Foundation, Cardiac Risk in the Young, NHS England, NIHR.
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