A prediction model for sudden cardiac death in patients with heart failure and preserved ejection fraction. (10th October 2014)

• Record Type: Journal Article
• Authors: Adabag, Selcuk; Rector, Thomas S.; Anand, Inder S.; McMurray, John J.; Zile, Michael; Komajda, Michel; McKelvie, Robert S.; Massie, Barry; Carson, Peter E.
• Is Part Of: European journal of heart failure. Volume 16:Number 11(2014)
• Page Start: 1175
• Page End: 1182
• Publication Date: 2014-10-10
• Subjects: Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.172
• Languages: English
• ISSNs: 1388-9842

Abstract

<abstract abstract-type="main" id="ejhf172-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ejhf172-sec-0001" sec-type="section"> <title>Aims</title> <p id="ejhf172-para-0001">Sudden cardiac death (SCD) accounts for ∼ 25% of all deaths in heart failure with preserved ejection fraction (HFpEF). However, strategies to identify HFpEF patients at a higher risk of SCD have not been developed.</p> </sec> <sec id="ejhf172-sec-0002" sec-type="section"> <title>Methods and results</title> <p id="ejhf172-para-0002">We studied 4128 patients with HFpEF enrolled in the Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction (I‐PRESERVE) trial. All SCDs were adjudicated by a clinical endpoint committee. Cumulative incidences of SCD were estimated counting other deaths as competing risks. Cox regression analysis was used to generate a risk model for SCD. During a mean follow‐up of 4.1 years, 231 (5.6%) patients died suddenly and 650 (15.7%) died non‐suddenly. A multivariable model in 3480 patients including age, gender, history of diabetes and myocardial infarction, LBBB on ECG, and the natural logarithm of NT‐proBNP identified a subgroup of 837 (24%) patients with ≥10% cumulative incidence of SCD over 5 years, accounting for other deaths as competing risk (Harrell's C index 0.75). The 5‐year cumulative incidences of SCD in the higher and lower risk groups were 11% and 4%, respectively. In the higher risk group, 32% of deaths were SCD compared with 26% in the entire I‐PRESERVE cohort.</p> </sec> <sec id="ejhf172-sec-0003" sec-type="section"> <title>Conclusions</title> <p id="ejhf172-para-0003">A multivariable prediction model identified patients with HFpEF who have a ≥10% risk of SCD over 5 years, similar to the risk of SCD in the Sudden Cardiac Death in Heart Failure (SCD‐Heft) trial. This model may be useful for selecting patients with HFpEF for SCD prevention trials.</p> </sec> </abstract>