title: A prediction model for sudden cardiac death in patients with heart failure and preserved ejection fraction.
abstract: OBJECTIVE
  Sudden cardiac death (SCD) accounts for ∼ 25% of all deaths in heart failure with preserved ejection fraction (HFpEF). However, strategies to identify HFpEF patients at a higher risk of SCD have not been developed.
  
  
  RESULTS
  We studied 4128 patients with HFpEF enrolled in the Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction (I-PRESERVE) trial. All SCDs were adjudicated by a clinical endpoint committee. Cumulative incidences of SCD were estimated counting other deaths as competing risks. Cox regression analysis was used to generate a risk model for SCD. During a mean follow-up of 4.1 years, 231 (5.6%) patients died suddenly and 650 (15.7%) died non-suddenly. A multivariable model in 3480 patients including age, gender, history of diabetes and myocardial infarction, LBBB on ECG, and the natural logarithm of NT-proBNP identified a subgroup of 837 (24%) patients with ≥10% cumulative incidence of SCD over 5 years, accounting for other deaths as competing risk (Harrell's C index 0.75). The 5-year cumulative incidences of SCD in the higher and lower risk groups were 11% and 4%, respectively. In the higher risk group, 32% of deaths were SCD compared with 26% in the entire I-PRESERVE cohort.
  
  
  CONCLUSIONS
  A multivariable prediction model identified patients with HFpEF who have a ≥10% risk of SCD over 5 years, similar to the risk of SCD in the Sudden Cardiac Death in Heart Failure (SCD-Heft) trial. This model may be useful for selecting patients with HFpEF for SCD prevention trials.
authors.affiliation: Veterans Affairs Health Care System, Minnesota, MN, USA; University of Minnesota, Minnesota, MN, USA.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Rector
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.forename: John J
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Michael
authors.initials: M
authors.lastname: Zile
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
authors.forename: Barry
authors.initials: B
authors.lastname: Massie
authors.forename: Peter E
authors.initials: PE
authors.lastname: Carson
mesh_terms: D000368:Aged; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D015337:Multicenter Studies as Topic; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis
keywords: Death, sudden; Heart failure; Prognosis; Risk factors