Dynamic changes in cardiovascular and systemic parameters prior to sudden cardiac death in heart failure with reduced ejection fraction: a PARADIGM‐HF analysis

• Published in: European journal of heart failure 2021-08, Vol.23 (8), p.1346-1356
• Main Authors: Rohde, Luis E., Vaduganathan, Muthiah, Claggett, Brian L., Polanczyk, Carisi A., Dorbala, Pranav, Packer, Milton, Desai, Akshay S., Zile, Michael, Rouleau, Jean, Swedberg, Karl, Lefkowitz, Martin, Shi, Victor, McMurray, John J.V., Solomon, Scott D.
• Format: Article
• Language: English
• Subjects: Cardiac and Cardiovascular Systems; Cardiovascular System & Cardiology; Clinical predictors; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - etiology; Defibrillators, Implantable; Heart failure; Heart Failure - epidemiology; Heart Failure - therapy; Humans; Kardiologi; Proportional Hazards Models; Risk Factors; Sudden cardiac death
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1002/ejhf.2120

Aims Prognostic models of sudden cardiac death (SCD) typically incorporate data at only a single time‐point. We investigated independent predictors of SCD addressing the impact of integrating time‐varying covariates to improve prediction assessment. Methods and results We studied 8399 patients enrolled in the PARADIGM‐HF trial and identified independent predictors of SCD (n = 561, 36% of total deaths) using time‐updated multivariable‐adjusted Cox models, classification and regression tree (CART), and logistic regression analysis. Compared with patients who were alive or died from non‐sudden cardiovascular deaths, patients who suffered a SCD displayed a distinct temporal profile of New York Heart Association (NYHA) class, heart rate and levels of three biomarkers (albumin, uric acid and total bilirubin), with significant differences observed more than 1 year prior to the event (Pinteraction