Where patients with mild to moderate heart failure die: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).
BACKGROUND
Common locations of death in patients with congestive heart failure (CHF) are unknown. In the SCD-HeFT, mortality of patients with CHF was assessed after randomization to an implantable cardioverter/defibrillator (ICD), amiodarone, or placebo. The aim of this study was to evaluate the location of deaths in SCD-HeFT.


METHODS
Among SCD-HeFT patients whose location of death was identified, we used logistic regression to assess the relationship of randomized treatment arm and other baseline predictors with the location of death. Cause of death was adjudicated by a therapy-blinded events committee.


RESULTS
In SCD-HeFT, 666 (26%) of 2521 patients died. Of the 604 (91%) for whom location of death was known, 58% died in hospital and 29% died at home. Patients randomized to receive an ICD were less likely to die at home than patients randomized to placebo (P = .002). Fewer patients randomized to ICDs died; even fewer randomized to ICDs died at home. Age, sex, etiology of heart failure, left ventricular ejection fraction, and New York Heart Association functional class were not associated with location of death. Sudden cardiac death represented 52% of all out-of-hospital deaths but in hospital deaths exceeded out-of-hospital deaths.


CONCLUSIONS
Deaths in SCD-HeFT, a well-treated CHF population, were most often in hospital. ICDs were associated with lower total and sudden death rates at home and in hospital. Development of methods to identify which patients will not respond to optimal treatment, including an ICD, remain a challenge.
Olshansky
Brian
B
Department of Internal Medicine, University of Iowa Hospitals, 4426A JCP, 200 Hawkins Dr, Iowa City, IA 52242, USA. brian-olshansky@uiowa.edu
Wood
Freda
F
Hellkamp
Anne S
AS
Poole
Jeanne E
JE
Anderson
Jill
J
Johnson
George W
GW
Boineau
Robin
R
Domanski
Michael J
MJ
Mark
Daniel B
DB
Lee
Kerry L
KL
Bardy
Gust H
GH
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use*; D002423:Cause of Death; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
D000638:Amiodarone