Loading...
A prediction model for sudden cardiac death in patients with heart failure and preserved ejection fraction
Adabag, Selcuk Rector, Thomas S. Anand, Inder S. McMurray, John J. V. Zile, Michael R. Komajda, Michel McKelvie, Robert S. Massie, Barry M. Carson, Peter E.
Adabag, Selcuk
Rector, Thomas S.
Anand, Inder S.
McMurray, John J. V.
Zile, Michael R.
Komajda, Michel
McKelvie, Robert S.
Massie, Barry M.
Carson, Peter E.
Abstract
Aims: 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. Methods and results: 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. Conclusions: 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.
Keywords
death, sudden, heart failure, risk factors, prognosis
Date
2014
Type
Journal article
Journal
European Journal of Heart Failure
Book
Volume
16
Issue
11
Page Range
1175-1182
Article Number
ACU Department
Collections
Relation URI
DOI
Source URL
Event URL
Open Access Status
License
File Access
Controlled