More than 80% of on-duty SCD events among US firefighters are due to coronary artery disease and hypertensive heart disease that may be prevented by early disease identification and risk factor modification.
Key Findings
Results
Postmortem evaluations were available for only about 38% of on-duty firefighter deaths, and about 39% of those were adjudicated as sudden cardiac death.
Postmortem reports (autopsy/medical examiner) were available for 794 of 2100 (37.8%) on-duty firefighter deaths from 1999-2014.
Average age of the 794 decedents was 44±13 years (range 17-82), and 4.0% were women.
312 of 794 (39.3%) deaths were adjudicated as SCD.
Primary etiology of each SCD was adjudicated by experts in sports cardiology and cardiovascular pathology.
Results
Coronary artery disease/ischemic heart disease and hypertensive heart disease accounted for most SCD events in firefighters.
255 of 312 (81.8%) SCD events were attributable to coronary artery disease/ischemic heart disease or hypertensive heart disease.
Both conditions are associated with traditional cardiovascular risk factors.
Results
Coronary artery disease/ischemic heart disease was also the leading cause of SCD among young firefighters (<40 years).
24 of 50 (48.0%) SCD cases in firefighters aged <40 years were attributed to coronary artery disease/ischemic heart disease.
Results
Among exertional SCD events attributed to coronary artery disease, most involved severe fixed coronary stenosis and about one-third involved acute plaque rupture/thrombosis.
The exertional SCD cohort thought secondary to coronary artery disease comprised n=97.
62 of 91 (68.1%) had severe fixed coronary stenosis.
29 of 91 (31.9%) had acute plaque rupture/thrombosis.
Conclusions
The authors conclude that most firefighter on-duty SCD may be preventable through earlier disease identification and risk factor modification, and call for studies of more rigorous screening and management.
SCD is described as the leading cause of duty-related death among firefighters.
The findings are intended to guide fire service cardiovascular screening and prevention programs.
Future studies should assess the efficacy of more rigorous firefighter cardiovascular disease screening and management practices.
What This Means
This study reviewed autopsy and medical examiner reports for US firefighters who died on duty between 1999 and 2014. Reports were available for 794 of 2,100 deaths. About 4 in 10 of those deaths (312) were judged to be sudden cardiac deaths, and expert reviewers determined the cause of each.
More than 80% of these sudden cardiac deaths were caused by coronary artery disease (clogged heart arteries) or hypertensive heart disease (heart damage from high blood pressure). These conditions are linked to common risk factors that can be identified and managed. Coronary artery disease was also the top cause among younger firefighters under 40 (about half of cases). Among exertional deaths from coronary disease, about two-thirds involved severe fixed artery narrowing and about one-third involved a sudden plaque rupture with clotting.
This research suggests that many on-duty cardiac deaths in firefighters stem from preventable, common heart conditions rather than rare inherited problems. The authors propose that earlier detection and risk factor control could reduce these deaths, but they note that studies are still needed to test whether more rigorous screening and management actually work. Postmortem reports were available for only about 38% of deaths, so the findings may not represent all cases.
Petek B, Layman A, Weller S, Dean J, Zurcher G, Ray J, et al.. (2026). Sudden Cardiac Death in Firefighters From the United States: A 16-Year Postmortem Analysis.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.051295