This article is more than 5 years old. Information may no longer be current.
Study highlights declining risk for sudden death among patients with HFrEF
The rate of sudden death in patients with symptomatic HF and reduced ejection fraction decreased by 44% over two decades, according to an analysis of 12 trials published in The New England Journal of Medicine.
“The decline in the rate of sudden death over this period paralleled the increasing use of evidence-based pharmacotherapies that are known to reduce the incidence of sudden death,” Li Shen, MB, ChB, from the Institute of Cardiovascular and Medical Sciences at the British Heart Foundation Glasgow Cardiovascular Research Center in Scotland, and colleagues wrote.
The researchers analyzed data from 40,195 patients (mean age, 65 years; 77% men) with symptomatic HF with reduced EF (HFrEF) who participated in 12 randomized controlled trials conducted from 1995 to 2014. The outcome of interest in this analysis was sudden death, which was calculated periodically after randomization.
Sudden death occurred in 8.9% of patients overall (n = 3,583). Sudden death was more likely in older men with lower systolic BP, lower left ventricular EF, worse HF symptoms, higher heart rate, an ischemic cause of HF and a history of diabetes, MI or renal dysfunction.
The risk for sudden death declined by 44% from 1995 to 2014 (HR = 0.56; 95% CI, 0.33-0.93). The cumulative incidence rate of sudden death at 90 days after randomization fluctuated during the study period, from 2.4% in the RALES trial (95% CI, 1.6-3.1) to 1% in the most-recent PARADIGM-HF trial (95% CI, 0.8-1.3).
In other findings, the rate of sudden death was not higher in patients with HF diagnosed 3 months or less before randomization compared with patients who had HF of a longer duration.
“The decreased risk of sudden death in contemporary trials involving patients with a high use of guideline-recommended therapies, coupled with data from previous trials and registries on the likely benefits and complications of [implantable cardioverter defibrillators], suggests that it may be difficult to show a significant benefit of ICD implantation for primary prevention in most patients with [HFrEF] in the current era,” Shen and colleagues wrote. – by Darlene Dobkowski
Disclosure: Shen reports no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.