P5667Predicting sudden cardiac death in Japanese heart failure patients: International validation of the Seattle Proportional Risk Model

Abstract Aims Heart failure (HF) is associated with an increased risk of sudden cardiac death (SCD). This study sought to demonstrate the incidence of SCD within a multicentre Japanese registry of HF patients hospitalized for acute decompensation, and externally validate the Seattle Proportional Risk Model (SPRM). Methods and results We consecutively registered 2240 acute HF patients from academic institutions in Tokyo, Japan. The discrimination and calibration of the SPRM were assessed by the c-statistic, Hosmer–Lemeshow statistic, and visual plotting among non-survivors. Patient-level SPRM predictions and implantable cardioverter-defibrillator (ICD) benefit [ICD estimated hazard ratio (HR), derived from the Cox proportional hazards model in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)] was calculated. During the 2-year follow-up, 356 deaths (15.9%) occurred, which included 76 adjudicated SCDs (3.4%) and 280 non-SCDs (12.5%). The SPRM showed acceptable discrimination [c-index = 0.63; 95% confidence interval (CI) 0.56–0.70], similar to that of original SPRM-derivation cohort. The calibration plot showed reasonable conformance. Among HF patients with reduced ejection fraction (EF; < 40%), SPRM showed improved discrimination compared with the ICD eligibility criteria (e.g. New York Heart Association functional Class II–III with EF ≤ 35%): c-index = 0.53 (95% CI 0.42–0.63) vs. 0.65 (95% CI 0.55–0.75) for SPRM. Finally, in the subgroup of 246 patients with both EF ≤ 35% and SPRM-predicted risk of ≥ 42.0% (SCD-HeFT defined ICD benefit threshold), mean ICD estimated HR was 0.70 (30% reduction of all-cause mortality by ICD). Conclusion The cumulative incidence of SCD was 3.4% in Japanese HF registry. The SPRM performed reasonably well in Japanese patients and may aid in improving SCD prediction.

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The relationship between aminoterminal propeptide of type III procollagen and heart rate variability parameters in heart failure patients: a potential serum marker to evaluate cardiac autonomic control and sudden cardiac death

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2010.348 ◽

2010 ◽

Vol 48 (12) ◽

Cited By ~ 6

Author(s):

Yen-Hung Lin ◽

Chen Lin ◽

Men-Tzung Lo ◽

Hung-Ju Lin ◽

Yen-Wen Wu ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Heart Rate Variability ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Serum Marker ◽

Autonomic Control ◽

Cardiac Autonomic Control ◽

Heart Failure Patients ◽

The Relationship

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Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review

European Heart Journal ◽

10.1093/eurheartj/ehz773 ◽

2019 ◽

Vol 41 (21) ◽

pp. 1976-1986 ◽

Cited By ~ 4

Author(s):

Sérgio Barra ◽

Rui Providência ◽

Kumar Narayanan ◽

Serge Boveda ◽

Rudolf Duehmke ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Cardiac Resynchronization Therapy ◽

Cardiac Death ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Heart Failure Patients ◽

The Difference ◽

Over Time

Abstract Aims While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failure patients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years. Methods and results Literature search from inception to 30 April 2018 for observational and randomized studies involving CRT patients, with or without defibrillator, providing specific cause-of-death data. Sudden cardiac death was the primary endpoint. For each study, rate of SCD per 1000 patient-years of follow-up was calculated. Trend line graphs were subsequently constructed to assess change in SCD rates over time, which were further analysed by device type, patient characteristics, and medical therapy. Fifty-three studies, comprising 22 351 patients with 60 879 patient-years of follow-up and a total of 585 SCD, were included. There was a gradual decrease in SCD rates since the early 2000s in both randomized and observational studies, with rates falling more than four-fold. The rate of decline in SCD was steeper than that of all-cause mortality, and accordingly, the proportion of deaths which were due to SCD declined over the years. The magnitude of absolute decline in SCD was more prominent among CRT-pacemaker (CRT-P) patients compared to those receiving CRT-defibrillator (CRT-D), with the difference in SCD rates between CRT-P and CRT-D decreasing considerably over time. There was a progressive increase in age, use of beta-blockers, and left ventricular ejection fraction, and conversely, a decrease in QRS duration and antiarrhythmic drug use. Conclusion Sudden cardiac death rates have progressively declined in the CRT heart failure population over time, with the difference between CRT-D vs. CRT-P recipients narrowing considerably.

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