Copyright © 2000 by the European Society of Cardiology.
Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24061 consecutive cases
a Department of Cardiopulmology, Benjamin Franklin Medical Center, Free University Berlin, Berlin, Germany
b Institute for Social Medicine and Epidemiology, Charite' Hospital, Humboldt University Berlin, Berlin, Germany
revised May 21, 1999; accepted May 26, 1999
Abstract
Aims Several studies have reported circadian and seasonal variations in acute cardiovascular disease. In addition, a weekly variation has been observed in acute myocardial infarction. The aim of our study was to determine the circadian weekly, and seasonal variations of sudden death utilizing population-based data.
Methods and Results We analysed the emergency medical system data of Berlin (West) from 1987–1991 with respect to all consecutive sudden deaths in subjects >18 years (n=24061). There was a marked circadian variation of sudden death, with a minimum between 0 and 6h and a maximum between 6 and 12h (P<0·0001) for every day of the week. A minimum of events occurred on Sundays (n=3143), and a maximum on Mondays (n=3721), corresponding to a relative increase of 18·3% (P<0·0001). The increase was more pronounced (23·6%) in patients 
65 than in patients >65 (15·7%). In addition, we found a significant seasonal variation (P<0·0001) in events, with a maximum during winter (December to February, n=6493), and a minimum during summer (June to August, n=5472), corresponding to a relative difference of 18·7%. The seasonal variation was more pronounced in patients >65 years.
Conclusion The present analyses demonstrate marked variations in the occurrence of sudden death with peaks during morning hours, on Mondays, and during winter months. The findings suggest that the onset of sudden death may be associated with endogenous rhythms and external factors including climatic conditions.
Key Words: Sudden death, emergency medical services, circadian variation, weekly variation, seasonal variation
f1 Correspondence: Priv.-Doz. Dr. med. Hans-Richard Arntz, Klinikum Benjamin Franklin, Dpt. Cardiopulmology, Hindenburgdamm 30, 12 200 Berlin, Germany.
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