Journal
EUROPEAN JOURNAL OF HEART FAILURE
Volume 16, Issue 11, Pages 1175-1182Publisher
WILEY-BLACKWELL
DOI: 10.1002/ejhf.172
Keywords
Death; sudden; Heart failure; Risk factors; Prognosis
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Funding
- Bristol-Myers Squibb
- Veterans Health Administration Health Services Research & Development Center of Innovation Grant [HFP-98-001]
- Center for Epidemiology and Clinical Research at the Minneapolis VA Medical Center
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AimsSudden cardiac death (SCD) accounts for approximate to 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 resultsWe 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. ConclusionsA 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.
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