Highlights
- •The proportion of SCD was significantly lower than expected based on the SPRM score.
- •The results were independent of the degree of predicted risk, ischemic etiology, the period of admission, and the presence of an implanted ICD.
- •The characteristics of our cohort might play a role in this lower than expected proportional risk of SCD.
Abstract
Background
The prediction of sudden cardiac death (SCD) in heart failure (HF) remains an unmet
need. The aim of our study was to assess the prevalence of SCD over 20 years in outpatients
with HF managed in a Mediterranean multidisciplinary HF Clinic, and to compare the
proportion of SCD (SCD/all-cause death) to the expected proportional occurrence based
on the validated Seattle Proportional Risk Model (SPRM) score.
Methods and Results
This prospective observational registry study included 2772 outpatients with HF admitted
between August 2001 and May 2021. Patients were included when the cause of death was
known and SPRM score was available. Over the 20-year study period, 1351 patients (48.7%)
died during a median follow-up period of 3.8 years (interquartile range 1.6–7.6).
Among these patients, the proportion of SCD out of the total of deaths was 13.6%,
whereas the predicted by SPRM was 39.6%. This lower proportion of SCD was observed
independently of left ventricular ejection fraction, ischemic etiology, and the presence
of an implantable cardiac defibrillator.
Conclusions
In a Mediterranean cohort of outpatients with HF, the proportion of SCD was lower
than expected based on the SPRM score. Future studies should investigate to what extend
epidemiological and guideline-directed medical therapy patterns influence SCD.
Graphical Abstract
Graphical Abstract
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiac FailureAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Declining risk of sudden death in heart failure.N Engl J Med. 2017; 377: 41-51
- ESC Scientific Document Group. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur Heart J. 2021; 42: 3599-3726
- Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure.N Engl J Med. 2005; 352: 225-237
- Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction.N Engl J Med. 2002; 346: 877-883
- β-Blockers for the prevention of sudden cardiac death in heart failure patients: a meta-analysis of randomized controlled trials.BMC Cardiovasc Disord. 2013; 13: 52
- The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.N Engl J Med. 1999; 341: 709-717
- Effect of the angiotensin-receptor-neprilysin inhibitor LCZ696 compared with enalapril on mode of death in heart failure patients.Eur Heart J. 2015; 36: 1990-1997
- Effect of dapagliflozin on ventricular arrhythmias, resuscitated cardiac arrest, or sudden death in DAPA-HF.Eur Heart J. 2021; 42: 3727-3738
- Defibrillator implantation in patients with nonischemic systolic heart failure.N Engl J Med. 2016; 375: 1221-1230
- Effect of sacubitril/valsartan on investigator-reported ventricular arrhythmias in PARADIGM-HF.Eur J Heart Fail. 2021; 23: 617-628
- Trends in modes of death in heart failure over the last two decades: less sudden death but cancer deaths on the rise.Eur J Heart Fail. 2019; 21: 1259-1266
- Predicted benefit of an implantable cardioverter-defibrillator: the MADIT-ICD benefit score.Eur Heart J. 2021; 42: 1676-1684
- A bio-clinical approach for prediction of sudden cardiac death in outpatients with heart failure: The ST2-SCD score.Int J Cardiol. 2019; 293: 148-152
- Applicability of a risk score for prediction of the long-term benefit of the implantable cardioverter defibrillator in patients receiving cardiac resynchronization therapy.EuroPace. 2016; 18: 1187-1193
- A novel method to predict the proportional risk of sudden cardiac death in heart failure: derivation of the Seattle Proportional Risk Model.Heart Rhythm. 2015; 12: 2069-2077
- Seattle Heart Failure and Proportional Risk Models predict benefit from implantable cardioverter-defibrillators.J Am Coll Cardiol. 2017; 69: 2606-2618
- Does the implantable cardioverter-defibrillator benefit vary with the estimated proportional risk of sudden death in heart failure patients?.JACC Clin Electrophysiol. 2017; 3: 291-298
- Improving the Use of Primary Prevention Implantable Cardioverter-Defibrillators Therapy With Validated Patient-Centric Risk Estimates.JACC Clin Electrophysiol. 2018 Aug; 4: 1089-1102
- Risk models for prediction of implantable cardioverter-defibrillator benefit: insights from the DANISH trial.JACC Heart Fail. 2019; 7: 717-724
- Prediction of sudden cardiac death in Japanese heart failure patients: international validation of the Seattle Proportional Risk Model.EuroPace. 2020; 22: 588-597
- Dynamic trajectories of left ventricular ejection fraction in heart failure.J Am Coll Cardiol. 2018; 72: 591-601
- Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial.Lancet. 2008; 372 (Epub 2008 Aug 29): 1231-1239https://doi.org/10.1016/S0140-6736(08)61240-4
- EMPHASIS-HF Study Group. Eplerenone in patients with systolic heart failure and mild symptoms.N Engl J Med. 2011; 364: 11-21https://doi.org/10.1056/NEJMoa1009492
- Clinical prevention of sudden cardiac death by n-3 polyunsaturated fatty acids and mechanism of prevention of arrhythmias by n-3 fish oils.Circulation. 2003; 107: 2646-2652
- Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial.Lancet. 2022; 399: 1876-1885
- Relationship of circulating vegetable omega-3 to prognosis in patients with heart failure.J Am Coll Cardiol. 2022; 80: 1751-1758https://doi.org/10.1016/j.jacc.2022.08.771
- Circulating linoleic acid at the time of myocardial infarction and risk of primary ventricular fibrillation.Sci Rep. 2022; 12: 4377
- Epidemiology of sudden cardiac death: global and regional perspectives.Heart Lung Circ. 2019; 28: 6-14
- Genetics of sudden cardiac death.Circ Res. 2015; 116: 1919-1936
Article info
Publication history
Published online: December 12, 2022
Accepted:
November 28,
2022
Received in revised form:
November 22,
2022
Received:
July 15,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
