The global landscape of SCD and approach to case work-up in Latin America: a LAHRS and SOBRAC survey.

backgroundSudden cardiac death (SCD) remains a major global public health problem, yet data from Latin America are scarce. The region accounts for nearly 660 million people (approximately 8% of the world's population), is highly admixed, and remains underrepresented in randomized controlled trials and cardiogenetic biobanks. Limited evidence exists on the epidemiology, diagnostic approaches, and use of cardiogenetic evaluation or molecular autopsy after unexplained SCD.

methodsWe conducted a descriptive cross-sectional survey, endorsed by the Latin American Heart Rhythm Society (LAHRS) and the Brazilian Society of Cardiac Arrhythmias (SOBRAC). The questionnaire (20 closed questions, available in Portuguese, Spanish, and English) was distributed through society mailing lists and local physician networks between March 24 and April 12, 2025. General practitioners, intensivists, and cardiologists practicing in Latin America were eligible. Responses were anonymous, and surveys with < 80% completion were excluded.

resultsA total of 439 physicians from 11 countries responded, most from Brazil (83.6%). Time in practice was heterogeneous: 38.7% reported < 10 years, 26.7% 10-20 years, and 34.6% >20 years. Only a minority considered regional out-of-hospital cardiac arrest (OHCA) systems efficient; 82% reported deficiencies in response times, training, and resources. The availability of automated external defibrillators (AEDs) in public spaces was reported as very limited (5.9%), and 88% indicated that BLS/ACLS educational initiatives were insufficient. Cardiogenetic infrastructure was also scarce: only 32 respondents (7.3%) reported access to specialized centers with counseling and testing, while 35% indicated genetic testing was available only in private settings. Familiarity with molecular autopsy was limited to 53.8%. Only 22% would order genetic testing after unexplained SCD, while 30.8% reported a lack of access or experience. In cases of unexplained SCD < 40 years, 76.5% reported screening relatives clinically, 49.2% would consider genetic testing of relatives, and 39.6% would seek post-mortem samples. Importantly, 85.2% of respondents expressed willingness to participate in a multicenter genetic protocol for SCD in young individuals.

conclusionThis first multinational survey provides a unique overview of SCD work-up in Latin America, highlighting critical gaps in OHCA response, cardiogenetic infrastructure, and molecular autopsy availability. Despite limited resources, there is strong interest in collaborative efforts, underscoring the urgent need for region-specific policies, multicenter protocols, and educational strategies to improve SCD care and prevention in Latin America.