[Sudden death in heart failure]

Our study was designed with the primary objective of evaluating the cardiac, overall and sudden mortality in patients with class IV heart failure (NYHA) managed with standard treatment and captopril (50 mg/8 hr. max.).

95 consecutive patients were enrolled in 21 hospitals and were followed for 6 months in order to design an interventional clinical trial to reduce sudden death.

Death occurred in 14 patients (14.7%; i.c. 8.3% - 23.5%; p < 0.05). There were no non-cardiovascular deaths in the group. There were 6 sudden death cases (42.9%; i.c. 16.9% - 68.8%, p < 0.05). Patients who died had a higher baseline end-diastolic (p < 0.05) and end-systolic (p < 0.01) diameter of the left ventricle (LV) and lower values of systolic (p < 0.01) and diastolic (p < 0.05) blood pressure. During the follow-up phase, heart rate, ventricular premature contraction, blood pressure and LV diameters decreased significantly in the whole group (p < 0.05, p < 0.001). We found no any differences during the follow-up phase between the patients who died and those who survived. In the patients who died we found no any differences between sudden death cases and the other death cases.

Sudden death was less frequent than we had expected and due to this fact it is impossible for us to design an interventional trial.