Abstract 1880: Increasing Age Decreases the Risk of Sudden Death Compared to Progressive Heart Failure in Patient with Advance Heart Failure
Background: Advancing age is a risk factor for mortality in patients with chronic heart failure (CHF). The proportion of sudden deaths (SD) compared to deaths from progressive heart failure (PHF) decreases as heart failure becomes more severe. Most patients with advanced heart failure are candidates for implantable cardiac defibrillators (ICDs) but the effect of age on the risk of SD vs PHF has not been studied. We hypothesized that increasing age would decrease the risk of SD/PHF in patients in the Beta-Blocker Evaluation of Survival Trial (BEST).
Methods: BEST enrolled patients with NYHA Class III and IV CHF and EF ≤ 35%. We evaluated the proportion of patients with SD in all patients with death due to either SD or PHF by decade.
Results: The mean age of all patients was 60 ± 12 years. The age range was 19–93 years. Of the 860 deaths, 647 were due to pump failure (n=262) or sudden death (n=385). For these 647 subjects, we used logistic regression to assess the probability of death being due to pump failure as a function of age, treatment group and baseline LVEF (an indicator of severity of CHF). Controlling for treatment group and baseline LVEF, age was significant (p=0.0002), with an odds ratio of 1.30 per decade. That is, for each increase of a decade of age, the odds of a death being due to pump failure, as opposed to sudden death, increases by a factor of 1.30. Treatment group and baseline LVEF were NS.
Conclusions: Increasing age is associated with a decreased risk of SD in patients with advanced CHF. This data, if verified in other studies, may have implications for the implantation of ICDs in older patients with advanced HF.