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Sudden cardiac death risk prediction in heart failure with preserved ejection fraction

  • Selçuk Adabag
    Correspondence
    Address reprint requests and correspondence: Dr Selçuk Adabag, Division of Cardiology (111C), Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417.
    Affiliations
    Division of Cardiology, Minneapolis VA Health Care System, Minneapolis, Minnesota

    Department of Medicine, University of Minnesota, Minneapolis, Minnesota

    Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
    Search for articles by this author
  • Lisa Langsetmo
    Affiliations
    Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
    Search for articles by this author
Published:December 12, 2019DOI:https://doi.org/10.1016/j.hrthm.2019.12.009

      Background

      Sudden cardiac death (SCD) comprises 25% of deaths in patients with heart failure with preserved ejection fraction.

      Objective

      We sought to validate a SCD risk prediction model in patients who participated in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial.

      Methods

      Of the 3445 Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial participants, 615 (18%) had data on all 6 variables—age, sex, history of myocardial infarction, history of diabetes mellitus, presence of bundle branch block on the electrocardiogram, and N-terminal pro-brain natriuretic peptide level—of the SCD risk prediction model. Those with a 5-year predicted risk of SCD ≥10% were categorized as high risk patients.

      Results

      Over a mean follow-up of 2.9 ± 1.3 years, there were 23 SCDs (3.7%) and 63 deaths from other causes (10.2%). The rate of mortality from SCD and other causes were 13 (95% confidence interval [CI] 9–19) and 35 (95% CI 28–45) per 1000 person-years of follow-up, respectively. A total of 216 participants (35.1%) were categorized as high risk by the SCD risk model. The estimated 5-year cumulative incidence of SCD was 15.2% (95% CI 6.6%–27.2%) in those classified as high risk vs 2.8% (95% CI 1.2%–5.5%) in those classified as low risk. In competing risk analysis, patients predicted to have high SCD risk had a 3.7-fold higher risk of SCD (hazard ratio 3.7; 95% CI 1.6–8.7; P = .003) than did those predicted to have low risk. The SCD risk model yielded a Harrell’s C index of 0.74.

      Conclusion

      A SCD risk prediction model including 6 widely available variables can identify patients with heart failure with preserved ejection fraction who had a high risk of SCD.

      Keywords

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