BACKGROUND: Sudden death (SD) and non-sudden cardiac death are responsible for the majority of deaths in patients with heart failure. We sought to identify the influence of comorbid illness (Charlson Comorbidity Index [CCI]) on competing modes of death in heart failure. METHODS: A retrospective analysis of 824 patients followed in a tertiary care heart failure clinic was performed. We analyzed the cumulative incidence of sudden and nonsudden death. Competing risk regression was used to examine the association between medical comorbidities and mode of death. The outcomes of interest were overall mortality, SD, SD and/or appropriate implantable cardioverter-defibrillator therapy (ICD), and non-SD. RESULTS: Mean age of the study population was 64.1 ± 14.7 years, 68.6% were male, and mean ejection fraction was 32.8% ± 13.5%. Over a mean follow-up of 4.4 years, 229 patients (27.8%) died. SD accounted for 33 deaths (14.4%), whereas SD/appropriate ICD therapy occurred in 56 patients (24.5%). The risk of non-SD and total mortality increased (P < .0001) as the CCI increased, whereas the risk of SD decreased (P = .03). The cumulative incidence of SD, SD and/or ventricular tachycardia/fibrillation, and non-SD at 5 years was 5.6%, 9.1%, and 27.8%, respectively. In multivariate competing risk analysis, advancing age, New York Heart Association class, and a CCI >4 were significantly associated with non-SD. CONCLUSION: Patients with heart failure with significant comorbidities are much more likely to sustain non-SD. These findings may have implications in optimal selection of patients with heart failure for interventions such as prophylactic ICD therapy.
BACKGROUND:Sudden death (SD) and non-sudden cardiac death are responsible for the majority of deaths in patients with heart failure. We sought to identify the influence of comorbid illness (Charlson Comorbidity Index [CCI]) on competing modes of death in heart failure. METHODS: A retrospective analysis of 824 patients followed in a tertiary care heart failure clinic was performed. We analyzed the cumulative incidence of sudden and nonsudden death. Competing risk regression was used to examine the association between medical comorbidities and mode of death. The outcomes of interest were overall mortality, SD, SD and/or appropriate implantable cardioverter-defibrillator therapy (ICD), and non-SD. RESULTS: Mean age of the study population was 64.1 ± 14.7 years, 68.6% were male, and mean ejection fraction was 32.8% ± 13.5%. Over a mean follow-up of 4.4 years, 229 patients (27.8%) died. SD accounted for 33 deaths (14.4%), whereas SD/appropriate ICD therapy occurred in 56 patients (24.5%). The risk of non-SD and total mortality increased (P < .0001) as the CCI increased, whereas the risk of SD decreased (P = .03). The cumulative incidence of SD, SD and/or ventricular tachycardia/fibrillation, and non-SD at 5 years was 5.6%, 9.1%, and 27.8%, respectively. In multivariate competing risk analysis, advancing age, New York Heart Association class, and a CCI >4 were significantly associated with non-SD. CONCLUSION:Patients with heart failure with significant comorbidities are much more likely to sustain non-SD. These findings may have implications in optimal selection of patients with heart failure for interventions such as prophylactic ICD therapy.
Authors: Alexandra M Hajduk; Jerry H Gurwitz; Grace Tabada; Frederick A Masoudi; David J Magid; Robert T Greenlee; Sue Hee Sung; Andrea E Cassidy-Bushrow; Taylor I Liu; Kristi Reynolds; David H Smith; Frances Fiocchi; Robert Goldberg; Thomas M Gill; Nigel Gupta; Pamela N Peterson; Claudio Schuger; Humberto Vidaillet; Stephen C Hammill; Heather Allore; Alan S Go Journal: J Am Geriatr Soc Date: 2019-03-20 Impact factor: 5.562
Authors: Yiyi Zhang; Robert Kennedy; Elena Blasco-Colmenares; Barbara Butcher; Sanaz Norgard; Zayd Eldadah; Timm Dickfeld; Kenneth A Ellenbogen; Joseph E Marine; Eliseo Guallar; Gordon F Tomaselli; Alan Cheng Journal: Heart Rhythm Date: 2014-05-02 Impact factor: 6.343
Authors: James A Fallavollita; Jonathan D Dare; Randolph L Carter; Sunil Baldwa; John M Canty Journal: Circ Cardiovasc Imaging Date: 2017-08 Impact factor: 7.792
Authors: Frederick A Masoudi; Alan S Go; David J Magid; Andrea E Cassidy-Bushrow; Jonathan M Doris; Frances Fiocchi; Romel Garcia-Montilla; Karen A Glenn; Robert J Goldberg; Nigel Gupta; Jerry H Gurwitz; Stephen C Hammill; John J Hayes; Nathaniel Jackson; Alan Kadish; Michael Lauer; Aaron W Miller; Deborah Multerer; Pamela N Peterson; Liza M Reifler; Kristi Reynolds; Jane S Saczynski; Claudio Schuger; Param P Sharma; David H Smith; Mary Suits; Sue Hee Sung; Paul D Varosy; Humberto J Vidaillet; Robert T Greenlee Journal: Circ Cardiovasc Qual Outcomes Date: 2012-11
Authors: Hoa L Nguyen; Quang Ngoc Nguyen; Duc Anh Ha; Dat Tuan Phan; Nguyen Hanh Nguyen; Robert J Goldberg Journal: PLoS One Date: 2014-10-03 Impact factor: 3.240