**5. Conclusions and future directions**

Sudden cardiac death remains a challenge for health providers and policy makers. Whether more stringent guidelines for prevention and screening will be applied is balanced by the enormous costs. In order to identify the groups at risk for sudden cardiac death there must first be a standardization of the definition. The worldly variation in this definition of sudden cardiac death of 1 hour from onset of symptoms to 24 hours, not only effects epidemiological data but also alters clinical trial outcomes when evaluating the effectiveness of treatment options.

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Currently, antiarrhythmic medications have failed to show any benefit of sudden cardiac death prevention, while traditional heart failure medications have been shown to decrease total mortality, sudden cardiac death and defibrillator shocks. They are only used in a small subset of patients that present in sudden cardiac death, since most of the patients who have sudden cardiac death have it as a first presentation and do not have congestive heart failure or history of coronary artery disease. This poses a diagnostic and therapeutic challenge for the clinician. Taking statins as an example, most of the primary prevention algorithms used to start lipid lowering agents usually leads to delayed intervention, especially since coronary atheroscle‐ rosis has been shown to start at a young age. The cost of starting this treatment is also enormous, especially if it is started on a global scale at a young age and it is not without side effects. Genetic studies to identify patients at risk for coronary atherosclerosis are still under devel‐ opment. Preventing sudden cardiac death is definitely a challenge for the 21st century clinician and might remain so for the near future.
