• LamTimothy Jia RongTJRYong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore., Jacqueline Yang, PohJane ElizabethJELee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore 636921, Singapore., OngMarcus Eng HockMEHDepartment of Emergency Medicine, Singapore General Hospital, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore., Nan Liu, Jun Wei Yeo, Jan-Thorsten Gräsner, Yoshio Masuda, and HoAndrew Fu WahAFWDepartment of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore. Electronic address: andrew.ho@duke-nus.edu.sg..
• Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore.
• Resuscitation. 2022 Jul 1; 176: 30-41.

AimsWith a growing number of survivors of sudden cardiac arrest globally, their natural disease progression is of interest. This systematic review and meta-analysis aimed to determine the risk of recurrence after sudden cardiac arrest and its associated risk factors.MethodsMedline, Embase, Cochrane Library and Scopus were searched from inception to October 2021. Studies involving survivors of an out-of-hospital sudden cardiac arrest event of any non-traumatic aetiology were included. Meta-analyses of proportions using the random-effects model estimated the primary outcome of first recurrent sudden cardiac arrest incidence as well as secondary outcomes including cumulative incidence of recurrence at 1-year and incidence of second recurrence among survivors of first recurrence. A recurrent episode was defined as a sudden cardiac arrest that occurs 28 or more days after the index event. Subgroup and meta-regression analyses were conducted for predetermined variables. The Newcastle-Ottawa Scale was used to assess risk of bias for most studies.Results35 studies of moderate to high quality comprising a total of 7186 survivors were analysed. The pooled incidence of first recurrence was 15.24% (32 studies; 95%CI, 11.01-19.95; mean follow-up time, 41.3 ± 29.3 months) and second recurrence was 35.03% (3 studies; 95%CI, 19.65-51.93; mean follow-up time, 161.1 ± 54.3 months). At 1-year, incidence of recurrence was 10.62% (3 studies; 95%CI, 0.25-30.42). Subgroup analyses found no significant difference (p = 0.204) between incidence of first recurrence published from 1975-1992 and 1993-2021, and between studies with mean follow-up time of <24 months, 24-48 months, and >48 months. On meta-regression, initial shockable rhythm increased incidence of first recurrence (p = 0.01).Conclusion15.24% of sudden cardiac arrest survivors experienced a recurrence, and of these, 35.03% experienced a second recurrence. Most recurrences occurred in the first year. Initial shockable rhythm increased this risk. Despite the limitations of inter-study heterogeneity, these findings can still guide intervention and follow-up of sudden cardiac arrest survivors.Copyright © 2022 Elsevier B.V. All rights reserved.

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