Declining risk of sudden death in heart failure

Shen, L. et al. (2017) Declining risk of sudden death in heart failure. New England Journal of Medicine, 377(1), pp. 41-51. (doi: 10.1056/NEJMoa1609758) (PMID:28679089)

Abstract

Background: The risk of sudden death has changed over time among patients with symptomatic heart failure and reduced ejection fraction with the sequential introduction of medications including angiotensin-converting–enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, and mineralocorticoid-receptor antagonists. We sought to examine this trend in detail. Methods: We analyzed data from 40,195 patients who had heart failure with reduced ejection fraction and were enrolled in any of 12 clinical trials spanning the period from 1995 through 2014. Patients who had an implantable cardioverter–defibrillator at the time of trial enrollment were excluded. Weighted multivariable regression was used to examine trends in rates of sudden death over time. Adjusted hazard ratios for sudden death in each trial group were calculated with the use of Cox regression models. The cumulative incidence rates of sudden death were assessed at different time points after randomization and according to the length of time between the diagnosis of heart failure and randomization. Results: Sudden death was reported in 3583 patients. Such patients were older and were more often male, with an ischemic cause of heart failure and worse cardiac function, than those in whom sudden death did not occur. There was a 44% decline in the rate of sudden death across the trials (P=0.03). The cumulative incidence of sudden death at 90 days after randomization was 2.4% in the earliest trial and 1.0% in the most recent trial. The rate of sudden death was not higher among patients with a recent diagnosis of heart failure than among those with a longer-standing diagnosis. Conclusions: Rates of sudden death declined substantially over time among ambulatory patients with heart failure with reduced ejection fraction who were enrolled in clinical trials, a finding that is consistent with a cumulative benefit of evidence-based medications on this cause of death. (Funded by the China Scholarship Council and the University of Glasgow.)

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Dargie, Professor Henry and Jhund, Professor Pardeep and Shen, Dr Li and Petrie, Professor Mark and McMurray, Professor John and Kober, Professor Lars and Cleland, Professor John
• Authors: Shen, L., Jhund, P. S., Petrie, M. C., Claggett, B. L., Barlera, S., Cleland, J. G.F., Dargie, H. J., Granger, C. B., Kjekshus, J., Køber, L., Latini, R., Maggioni, A. P., Packer, M., Pitt, B., Solomon, S. D., Swedberg, K., Tavazzi, L., Wikstrand, J., Zannad, F., Zile, M. R., and McMurray, J. J.V.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: New England Journal of Medicine
• Publisher: Massachusetts Medical Society
• ISSN: 0028-4793
• ISSN (Online): 1533-4406
• Copyright Holders: Copyright © 2017 Massachusetts Medical Society
• First Published: First published in New England Journal of Medicine 377(1): 41-51
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher