Heart Failure -> Heart Failure Management: -> Clinical Trials D-AB30 - Clinical Trials: Heart Failure and Implantable Devices (ID 37) Abstract Plus

D-AB30-03 - Sudden Death In Heart Failure With Preserved Cardiac Function: A Treatment Of Preserved Cardiac Function Heart Failure (TOPCAT) Americas Trial Substudy (ID 815)

 S. Saksena: Nothing relevant to disclose.


Background: Sudden cardiac death (SCD) & myocardial pump failure are major contributors to cardiovascular(CV) mortality in patients(pts) with heart failure (HF) with reduced systolic function(rEF) & presence of atrial fibrillation (AF) increases this risk. However, this relationship is unclear in pts with HF with preserved systolic function (pEF).
Objective: We examined the occurrence of SCD & aborted cardiac arrest (ACA) as well as HF progression in HFpEF pts. We compared pts with concomitant AF ( either on ECG or history of AF) to pts without any AF at baseline in the TOPCAT AMERICAS study.
Methods: Cox Proportional Hazards adjusted for baseline covariates were used to estimate the risk difference for patients with and without concomitant AF. HF progression was defined as time for transitioning from NYHA class I/II at baseline to III/IV during followup.
Results: 493 (40.5%) of 1142 HFpEF patients who were in NYHA I/II HF at baseline & 266 (42.9%) of 620 HFpEF patients who were in NYHA III/IV at baseline had concomitant AF. SCD & ACA event rates were relatively modest in both HF strata & concomitant AF did not significantly impact them (left and middle panel). HF progression during followup was often seen in pts presenting with class I/II HF at study entry & this was more frequent in the AF subgroup (p=0.019, right panel). Time dependent analysis did not show an adverse impact of AF on SCD or ACA event rates with HF progression.
Conclusion: 1. In pts with HFpEF, SCD is only a modest contributor to CV mortality, in contrast to pts with HFrEF. 2. Presence of concomitant AF does not increase the susceptibility of HFpEF pts to SCD or ACA. 3. HF progression is more common in AF pts with HFpEF but this did not increase SCD risk .