[Predictors of sudden death and death from heart failure in patients with heart insufficiency are different]
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B K Madsen1, V Rasmussen, J F Hansen
1Hvidovre Hospital, kardiologisk afdeling.
Insights
Identifying risk factors for congestive heart failure (CHF) deaths is crucial. Sudden cardiac death in CHF is linked to ventricular tachycardia and low magnesium, while pump failure is associated with advanced disease and low exercise tolerance.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Congestive heart failure (CHF) is a leading cause of mortality.
- Understanding distinct risk factors for different death modes in CHF is essential for targeted interventions.
Purpose of the Study:
- To identify specific risk factors associated with the two primary causes of death in patients with chronic congestive heart failure (CHF): sudden death and progressive pump failure.
Main Methods:
- A cohort of 190 patients discharged with CHF underwent comprehensive evaluations including clinical assessment, blood tests, imaging (chest X-ray, echocardiography, isotope ventriculography), exercise testing, and Holter monitoring.
- Multivariate analyses were employed to determine independent risk factors for mortality.
Main Results:
- Overall mortality rates were 21% at one year and 32% at two years.
- Sudden death accounted for 33% of deaths, with risk factors including ventricular tachycardia, low serum sodium, low serum magnesium, elevated serum creatinine, and limited heart rate variability during exercise.
- Progressive pump failure caused 49% of deaths, associated with advanced New York Heart Association (NYHA) class, reduced heart rate variability, low ejection fraction, elevated resting P-noradrenaline, high serum urea, low serum potassium, and short maximal exercise duration.
Conclusions:
- Distinct risk factor profiles exist for sudden death and death from pump failure in patients with CHF.
- These findings highlight the need for tailored management strategies based on the predicted mode of death in CHF patients.
Abstract:
The purpose was to identify risk factors for the two most common modes of death in chronic congestive heart failure (CHF) in 190 consecutive patients discharged with CHF. They were examined with clinical evaluation, blood chemistry, chest X-ray, exercise testing, echocardiography, isotope ventriculography and Holter monitoring. Mortality after one year was 21%, after two years 32%. Of 60 deaths, 33% were sudden and 49% due to pump failure. Multivariate analyses identified totally different risk factors for sudden death: ventricular tachycardia, S-sodium < or = 137 mmol/l, S-magnesium < or = 0.80 mmol/l, S-creatinine > 121 mumol/l, and maximal change in heart rate during exercise < or = 35/min. For death from progressive pump failure: New York Heart Association class 3 + 4, delta heart rate over 24 h < or = 50/min, low ejection fraction, high resting P-noradrenaline, S-urea > 7.6 mmol/l, S-potassium < 3.5 mmol/l, and maximal exercise duration < or = 4 min.
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