Sudden cardiac death after acute heart failure hospital admission: insights from ASCEND-HF

Eur J Heart Fail. 2018 Mar;20(3):525-532. doi: 10.1002/ejhf.1078. Epub 2017 Dec 20.

Abstract

Aims: The incidence of and factors associated with sudden cardiac death (SCD) early after an acute heart failure (HF) hospital admission have not been well defined.

Methods and results: We assessed SCD and ventricular arrhythmias in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial, which included patients with acute HF with reduced or preserved ejection fraction. SCD, resuscitated SCD (RSCD), and sustained ventricular tachycardia/ventricular fibrillation (VT/VF) were adjudicated from randomization through 30 days and were combined into a composite endpoint. Baseline characteristics associated with this composite were determined by logistic regression. RSCD and VT/VF were included as time-dependent variables in a Cox model evaluating the association of these variables with 180-day all-cause mortality. Among 7011 patients, the 30-day all-cause mortality rate was 3.8%; SCD accounted for 17% of these deaths. The 30-day composite event rate was 1.8% (n = 121). Ten patients had more than one event with 30-day Kaplan-Meier event rates of 0.6% for SCD [95% confidence interval (CI) 0.5%-0.9%, n = 43], 0.4% for RSCD (95% CI 0.2%-0.5%, n = 24), and 0.9% for VT/VF (95% CI 0.7%-1.2%, n = 64). In the multivariable model, chronic obstructive pulmonary disease, history of VT, male sex, and longer QRS duration were associated with SCD, RSCD, or VT/VF. A RSCD or VT/VF event was associated with higher 180-day mortality (adjusted hazard ratio 6.6, 95% CI 4.8-9.1, P < 0.0001).

Conclusions: Approximately 2% of patients admitted for acute HF experienced SCD, RSCD, or VT/VF within 30 days of admission, and SCD accounted for 17% of all deaths within 30 days.

Keywords: Heart failure; Implantable cardioverter-defibrillator; Sudden cardiac death; Ventricular fibrillation; Ventricular tachycardia.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Cause of Death / trends
  • Death, Sudden, Cardiac / epidemiology*
  • Death, Sudden, Cardiac / etiology
  • Female
  • Heart Failure / complications*
  • Heart Failure / drug therapy
  • Heart Failure / mortality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Natriuretic Agents / therapeutic use
  • Natriuretic Peptide, Brain / therapeutic use*
  • Patient Admission*
  • Risk Assessment*
  • Risk Factors
  • Stroke Volume / physiology
  • Survival Rate / trends
  • Treatment Outcome
  • United States / epidemiology

Substances

  • Natriuretic Agents
  • Natriuretic Peptide, Brain