Declining Risk of Sudden Death in Heart Failure
Open Access
- 6 July 2017
- journal article
- research article
- Published by Massachusetts Medical Society in The New England Journal of Medicine
- Vol. 377 (1), 41-51
- https://doi.org/10.1056/nejmoa1609758
Abstract
The 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. We 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. Sudden 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. Rates 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.)Keywords
This publication has 37 references indexed in Scilit:
- 2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive SummaryCirculation, 2013
- Beta-blockers for the prevention of sudden cardiac death in heart failure patients: a meta-analysis of randomized controlled trialsBMC Cardiovascular Disorders, 2013
- Effects of Mineralocorticoid Receptor Antagonists on the Risk of Sudden Cardiac Death in Patients With Left Ventricular Systolic DysfunctionCirculation: Heart Failure, 2013
- ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012European Journal of Heart Failure, 2012
- Systolic Heart FailureThe New England Journal of Medicine, 2010
- A Critical Appraisal of Implantable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac DeathJournal of the American College of Cardiology, 2008
- Amiodarone or an Implantable Cardioverter–Defibrillator for Congestive Heart FailureThe New England Journal of Medicine, 2005
- Effect of Candesartan on Cause-Specific Mortality in Heart Failure PatientsCirculation, 2004
- Prophylactic Implantation of a Defibrillator in Patients with Myocardial Infarction and Reduced Ejection FractionThe New England Journal of Medicine, 2002
- Effect of angiotensin converting enzyme inhibition on sudden cardiac death in patients following acute myocardial infarction: A meta-analysis of randomized clinical trialsJournal of the American College of Cardiology, 1999