Title |
Sudden Death in Heart Failure With Preserved Ejection Fraction A Competing Risks Analysis From the TOPCAT Trial
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Published in |
JACC: Heart Failure, March 2018
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DOI | 10.1016/j.jchf.2018.02.014 |
Pubmed ID | |
Authors |
Muthiah Vaduganathan, Brian L Claggett, Neal A Chatterjee, Inder S Anand, Nancy K Sweitzer, James C Fang, Eileen O'Meara, Sanjiv J Shah, Sheila M Hegde, Akshay S Desai, Eldrin F Lewis, Jean Rouleau, Bertram Pitt, Marc A Pfeffer, Scott D Solomon |
Abstract |
Sudden death (SD) may be an important mode of death in heart failure with preserved ejection fraction (HFpEF). To investigate rates and predictors of SD or aborted cardiac arrest (ACA) in HFpEF. We studied 1,767 patients with HFpEF (EF≥45%) enrolled in the Americas region of the TOPCAT trial. We identified independent predictors of composite SD/ACA with step-wise backward selection using competing risks regression analysis accounting for non-sudden causes of death. During median 3.0 (1.9-4.4) year follow-up, 77 patients experienced SD/ACA and 312 experienced non-SD/ACA. Corresponding incidence rates were 1.4 (1.1-1.8) and 5.8 (5.1-6.4) events/100 patient-years. SD/ACA was numerically lower but not statistically reduced in those randomized to spironolactone: 1.2 (0.9-1.7) vs. 1.6 (1.2-2.2) events/100 patient-years; subdistributional HR 0.74 95% CI 0.47-1.16; P=0.19. After accounting for competing risks of non-sudden death, male sex and insulin-treated diabetes mellitus were independently predictive of composite SD/ACA (C-statistic 0.65). Covariates-including eligibility criteria, age, ejection fraction, coronary artery disease, LBBB, and baseline therapies-were not independently associated with SD/ACA. Sex and diabetes mellitus status remained independent predictors in sensitivity analyses excluding patients with implantable cardioverter-defibrillators and when predicting SD alone. SD accounted for ∼20% of deaths in HFpEF. Male sex and insulin-treated diabetes mellitus identify patients at higher risk for SD/ACA with modest discrimination. These data may guide future SD-preventative efforts in HFpEF. TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist); ClinicalTrials.gov Unique Identifier: NCT00094302. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
Spain | 19 | 18% |
United States | 11 | 11% |
Venezuela, Bolivarian Republic of | 7 | 7% |
Mexico | 5 | 5% |
Argentina | 5 | 5% |
France | 3 | 3% |
Colombia | 2 | 2% |
Italy | 1 | <1% |
Germany | 1 | <1% |
Other | 12 | 12% |
Unknown | 37 | 36% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 71 | 69% |
Practitioners (doctors, other healthcare professionals) | 17 | 17% |
Science communicators (journalists, bloggers, editors) | 10 | 10% |
Scientists | 5 | 5% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 72 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 8 | 11% |
Student > Master | 7 | 10% |
Student > Bachelor | 6 | 8% |
Student > Doctoral Student | 5 | 7% |
Researcher | 5 | 7% |
Other | 12 | 17% |
Unknown | 29 | 40% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 26 | 36% |
Pharmacology, Toxicology and Pharmaceutical Science | 2 | 3% |
Nursing and Health Professions | 2 | 3% |
Mathematics | 1 | 1% |
Biochemistry, Genetics and Molecular Biology | 1 | 1% |
Other | 5 | 7% |
Unknown | 35 | 49% |