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Updated: Apr 22, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
A prediction model for sudden cardiac death in patients with heart failure and preserved ejection fraction
Selcuk Adabag1, Thomas S Rector, Inder S Anand
1Veterans Affairs Health Care System, Minnesota, MN, USA; University of Minnesota, Minnesota, MN, USA.
Insights
Sudden cardiac death (SCD) is a major concern in heart failure with preserved ejection fraction (HFpEF). A new risk model identifies HFpEF patients with a high risk of SCD, aiding in prevention strategies.
Area of Science:
- Cardiology
- Clinical Trials
- Predictive Modeling
Background:
- Sudden cardiac death (SCD) constitutes a significant portion of mortality in heart failure with preserved ejection fraction (HFpEF).
- Current strategies for identifying high-risk HFpEF patients for SCD are lacking.
- Developing predictive models is crucial for targeted interventions.
Purpose of the Study:
- To develop and validate a multivariable prediction model for identifying HFpEF patients at elevated risk of SCD.
- To assess the 5-year cumulative incidence of SCD in identified high-risk subgroups.
- To inform patient selection for future SCD prevention trials in HFpEF.
Main Methods:
- Analysis of 4128 HFpEF patients from the I-PRESERVE trial.
- Adjudication of all SCD events by a clinical endpoint committee.
- Development of a Cox regression-based multivariable model incorporating clinical and biomarker data (age, gender, diabetes, myocardial infarction, LBBB, NT-proBNP).
Main Results:
- A multivariable model identified 24% of patients with a ≥10% cumulative incidence of SCD over 5 years.
- The 5-year SCD cumulative incidence was 11% in the high-risk group versus 4% in the lower-risk group.
- The model demonstrated good discrimination (Harrell's C index 0.75).
Conclusions:
- A validated multivariable model effectively identifies HFpEF patients at high risk for SCD.
- The identified high-risk group has an SCD risk comparable to that seen in the SCD-Heft trial.
- This model can facilitate the selection of appropriate candidates for SCD prevention trials in HFpEF.
Aims:
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.
Methods And 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.
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