Abstract 17304: Sudden Cardiac Death After Acute Heart Failure Hospitalization: Insights From ASCEND-HF
Introduction: Despite concerns about sudden cardiac death (SCD) early after acute heart failure (AHF) hospitalization, the incidence of SCD and the factors and associated with its occurrence have not been well defined. We evaluated the incidence and predictors of SCD early after AHF hospitalization.
Hypothesis: AHF is associated with SCD.
Methods: ASCEND-HF included patients with AHF with any ejection fraction (EF). Clinical events including SCD, resuscitated SCD (RSCD), and sustained ventricular tachycardia/ventricular fibrillation (VT/VF) were adjudicated through 30 days. Patients could have more than one event. These three events were combined to form a new composite endpoint, and baseline characteristics associated with this composite were determined by logistic regression and stepwise selection. RSCD and VT/VF were used as time dependent variables in a Cox model to evaluate the association with 180-day all-cause mortality.
Results: Among 7,011 patients with available date on SCD, RSCD, or VT/VF, median age was 67 years (IQR 56-76), median EF was 30% (IQR 20-37%), 9% had a history of VT, and 16% had an ICD. The 30-day event rates were 1.8% (n=121) for the composite, 0.6% for SCD (n=43), 0.4% for RSCD (n=24), and 0.9% for VT/VF (n=64). In the multivariable model, chronic obstructive pulmonary disease, history of VT, male sex, higher admission heart rate, and longer baseline QRS duration were associated with SCD, RSCD, or VT/VF (Table). The composite was independently associated with higher 180-day mortality (adjusted HR 6.6, 95% CI 4.8-9.1, p<0.0001).
Conclusions: Patients admitted for AHF had relatively high rates of SCD, RSCD, or VT/VF within 30 days of follow-up, and RSCD or VT/VF were associated with higher 180-day mortality. Further studies are needed to evaluate ways to predict and therapies to prevent and treat tachyarrhythmias early after AHF hospitalization, including in those patients who may be eligible for an ICD after medical therapy has been optimized.
Author Disclosures: S. Pokorney: Research Grant; Modest; Boston Scientific, Gilead, AstraZeneca. Consultant/Advisory Board; Modest; Janssen, Medtronic. S.M. Al-Khatib: None. J. Sun: None. P. Schulte: None. C.M. O'Connor: Research Grant; Significant; Jonson and Johnson. J.R. Teerlink: Research Grant; Significant; Johnson and Johnson. Consultant/Advisory Board; Modest; Johnson and Johnson, Merck and Company, Amgen, St. Jude, Cytokinetics, Novartis. P.W. Armstrong: Research Grant; Significant; Johnson and Johnson. J.A. Ezekowitz: Research Grant; Significant; Scios, Johnson and Johnson, Janssen Pharmaceuticals, Ortho-Biotech. R.C. Starling: Research Grant; Modest; Medtronic, BIotronik. Research Grant; Significant; NIH. Ownership Interest; Modest; CardioMEMS. Consultant/Advisory Board; Modest; Medtronic, BioControl, Novartis. A.A. Voors: Research Grant; Modest; Alere, AstraZeneca, Bayer, Merck, Novartis, Servier. Research Grant; Significant; Johnson and Johnson, Boehringer Ingelheim. Consultant/Advisory Board; Modest; Novartis. E.C. Velazquez: None. A.F. Hernandez: Research Grant; Significant; American Heart Association, Novartis. Honoraria; Modest; Novartis, Janssen Pharmaceuticals, Bristol-Myers Squibb. R.J. Mentz: Research Grant; Modest; NIH, Novartis, Bristol-Myers Squibb, Gilead, AstraZeneca, GlaxoSmithkline. Honoraria; Modest; Thoratec.
- © 2015 by American Heart Association, Inc.