Dynamic Risk Trajectories for Sudden Cardiac Arrest: The Role of Recurrent Cardiovascular Events.

Area of Science:

• Cardiology
• Epidemiology
• Public Health

Background:

• Dynamic risk assessment may improve sudden cardiac arrest (SCA) risk stratification.
• Previous cardiovascular events like acute coronary syndrome (ACS) and heart failure (HF) hospitalization increase SCA risk.
• The impact of recurrent cardiovascular events on subsequent SCA risk in real-world populations remains unclear.

Purpose of the Study:

• To determine if patients with a first-time ACS or HF hospitalization who experience a recurrent cardiovascular event have a higher risk of SCA.
• To evaluate the association between recurrent cardiovascular events and subsequent SCA risk in a contemporary, real-world cohort.

Main Methods:

• Prospective cohort study (Observational Study of Cardiac Arrest Risk - OSCAR) with adjudicated SCA outcomes.
• Patients surviving a first ACS or HF hospitalization were followed for recurrent events and SCA.
• Cox models with time-dependent variables assessed the association between recurrent events and SCA; findings were validated in the Framingham Heart Study (FHS).

Main Results:

• In the OSCAR cohort, recurrent ACS events were linked to a >3-fold higher SCA risk (adjusted HR 3.15).
• Recurrent HF hospitalizations were associated with an 80% higher SCA risk (HR 1.81).
• Validation in FHS showed a significant association between recurrent ACS and SCA risk (HR 2.85) but not for recurrent HF.

Conclusions:

• Recurrent ACS events significantly elevate SCA risk, while recurrent HF hospitalizations also increase SCA risk.
• Dynamic clinical trajectories of recurrent cardiovascular events may offer insights for SCA management and prevention strategies.
• These findings underscore the importance of monitoring for recurrent events in patients with prior ACS or HF.