A prediction model for sudden cardiac death in patients with heart failure and preserved ejection fraction

Adabag, S., Rector, T. S., Anand, I. S., McMurray, J. J. , Zile, M., Komajda, M., McKelvie, R. S., Massie, B. and Carson, P. E. (2014) A prediction model for sudden cardiac death in patients with heart failure and preserved ejection fraction. European Journal of Heart Failure, 16(11), pp. 1175-1182. (doi: 10.1002/ejhf.172)

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.<p></p> 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.<p></p> 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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Adabag, S., Rector, T. S., Anand, I. S., McMurray, J. J., Zile, M., Komajda, M., McKelvie, R. S., Massie, B., and Carson, P. E.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Journal of Heart Failure
• Publisher: John Wiley & Sons Ltd.
• ISSN: 1388-9842
• ISSN (Online): 1879-0844