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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Article Info
Publication History
Published online: December 12, 2019
Footnotes
This study was supported by a Grant-in-Aid from the American Heart Association , Dallas, TX (grant no. 17GRNT33670993 ).
Dr Adabag has received research grants from the American Heart Association and Medtronic . Dr Langsetmo reports no conflicts of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of Heart Rhythm Society.
