Heart failure & cardiomyopathies
Heart Failure Burden by Autopsy, Guideline-Directed Medical Therapy, and Implantable Cardioverter-defibrillator (ICD) Utilization Among Sudden Deaths
Authors' conclusion
One in 5 community sudden deaths had HF; two-thirds had autopsy-confirmed arrhythmic causes. ICD prevention criteria captured only 8% (22 of 293) of all SAD cases countywide
Study context
- Population
- Autopsied WHO-defined (presumed) sudden cardiac death (SCDs), ages 18–90 years, San Francisco County, 2011–2014 (POST SCD study)
- Participants
- 525 presumed SCDs
- Exposure
- Heart Failure with Reduced Ejection Fraction (HFrEF) vs HFpEF vs Subclinical Heart Failure (HF)
- HFrEFn = 54
- HFpEFn = 31
- Subclinical HFn = 15
- Outcome
- Burden of HF, GDMT and ICD use among autopsied sudden deaths
Methodological detailscountywide, consecutive out-of-hospital deaths, autopsy-based
- Countywide
- Consecutive out-of-hospital deaths
- Autopsy-based
Main finding
As reported in the abstract
HF among presumed SCDs; SAD among HF SCDs
| Group | Value | SAD |
|---|---|---|
| HFrEF | 74% | 40 of 54 [74%] |
| HFpEF | 61% | 19 of 31 [61%] |
Value
HFrEF74%
HFpEF61%
SAD
HFrEF40 of 54 [74%]
HFpEF19 of 31 [61%]
- HFrEF vs HFpEF: P = 0.45 — SAD rate
- Presumed SCDs with HF
- 100 (19%)
- Sudden arrhythmic deaths (SADs) among all presumed SCDs
- 56% (293 of 525)
- SADs among HF SCDs
- 69% (69 of 100)
- Complete guideline-directed medical therapy (GDMT) use in HFrEF
- 6%
- SAD patients with ICDs
- Four (4%)
Observational data: associations, not effects.
Further findings
- SCDs with EF ≤35%
- 28
- Arrhythmic causes
- 22 (79%)
- Noncardiac causes
- 6 (21%)
- SAD with no identifiable barrier to ICD referral
- 8 (36%)
Safety
ICD device failure among SAD patients with ICDs
- Device failure
- 3 of 4
Original publication
Heart Failure Burden by Autopsy, Guideline-Directed Medical Therapy, and ICD Utilization Among Sudden Deaths. JACC Clin Electrophysiol. Published 30 November 2022. doi:10.
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