Declining Risk of Sudden Death in Heart Failure

Abstract

BACKGROUNDThe 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. METHODSWe 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. RESULTSSudden 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. CONCLUSIONSRates 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.)A BS TR AC T

The year in cardiology 2017: heart failure

“…[31][32][33][34] Patients in these meta-analyses may have had less effective medical therapy than contemporary patients. Indeed, a large analysis form 12 clinical trials suggested that the rates of sudden death have declined over time (Figure 1), 35 which would be consistent with potentially lower benefit of primary prevention ICD in patients with contemporary treatment. Furthermore, benefits may differ substantially depending on e.g.…”

Sudden death Heart Pathology - A New Research Hipotesys in Drug Design strategy

“…AS we have see in the citated references sudden death must be deeply studied in order to better clarify the pathologic cause [1][2][3] especially in young people. To prevent this kind of disease we think can be useful introduce new diagnostic strategy to verify in stressing conditions the local methabolic heart performance.…”

“…Shen et al [2] showed that "The risk of SCD has changed over time among patients with symptomatic HF and reduced ejection fraction with sequential introduction of drugs as ACE inhibitors, angiotensin-receptor blockers, beta-blockers drugs, and mineralcorticoid-receptor antagonists" [2].…”

American perspective: Comparing the AHA/ACC and ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…SCA remains a leading cause of mortality in the general population yet, over the last 20 years, the rate of arrhythmic death in the heart failure population has declined with the broad implementation of angiotensin converting inhibitors, beta blockers and aldosterone antagonists in patients with heart failure 23 . While there is general agreement among the cardiology community about the need to better target patients for primary prevention ICDs, consensus in refining the guidelines and implementing new risk stratification approaches employing advanced imaging as well as other biomarkers will require continued joint collaboration among the imaging, electrophysiological and clinical cardiology communities on an international basis.…”