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Addressing the Risk for SuddenCardiac Death in Heart Failure

Panelists

Philip B. Adamson, MDDirector, Heart Failure Institute

Oklahoma Heart HospitalDirector, Oklahoma Foundation for

Cardiovascular ResearchAdjunct Associate Professor of Physioloy!niversity of Oklahoma Health "ciences

CenterOklahoma City, Oklahoma

Paul Hauptman, MD

Professor of Internal #edicineDivision of Cardioloy

Assistant Dean, Clinical and $ranslationalResearch

"aint %ouis !niversity "chool of #edicine"t& %ouis, #issouri

Moderator 

Scott D. Solomon, MDProfessor of #edicine

Harvard #edical "choolDirector, 'oninvasive Cardioloy

Director, Cardiac Imain Core%a(oratory and Clinical $rials

)ndpoints Center*riham and +omens Hospital

*oston, #assachusetts

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earning !"#ecti$es

- Identify persistent treatment aps forpeople .ith HF

- )valuate potential mechanismsunderlyin the risk for "CD and HF

- Assess the role of ICDs and +CDs toaddress the risk of "CD in patients.ith ischemic and nonischemic HF

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%ho &s at Risk of SCD'

- Patients .ith lo. )F- Family history

- Risk strati/cation can help delineatehih, moderate, and lo. risk

- Patients .ith preserved left ventricularfunction may have lo.er risk of "CD(ut still have hih mortality risk

0 Hypokalemia and meta(olic a(normalities

0 "ymptomatoloy often has inverse relationto "CD

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(A&A)*+ Patients %ith a First orSu"seuent Acute M& Complicated

"- HF, eft (entricular S-stolicD-sfunction, or Both

"olomon "D, et al&123

•

n 4 25,678• 2769 had an

event :median,2;7 days after #I<• 87= died suddenly• 265 .ere

resuscitated aftercardiac arrest•  $he risk .as

hihest in the /rst=7 days after #I

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8/20/2019 Addressing the Risk for Sudden Cardiac Death in Heart Failure_slides

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Presumedarrh-thmic deathn / 012345M-ocardial infarction

675

M-ocardial ruptures

815

Pump failure35

!ther C( death15

)on9C( death65

• 65 of inde: M&• 1;5 of

recurrent M&

Breakdone:pected Death? "-Autops- Results in (A&A)*

Pouleur AC, et al&1>3

) /870

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Cause of Death

Type of Death DINAMIT (n = 342)

Sudden, presumed

arrhythmic

29 (54%)

Cardiac, non-

arrhythmic

17 (31%)

oncardiac ! (15%)

"ota# 54 (1$%)

Dorian D, et al&1=3

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8/20/2019 Addressing the Risk for Sudden Cardiac Death in Heart Failure_slides

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*-pes of Arrh-thmias

•

>? to @? are pro(a(lyunrecovera(le

• ;@? to 87? are

tachyarrhythmias• )lectromechanical disassociation

P)Atype

• "ustained (radyarrhythmiasaccount for may(e 27?

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CMS, the )ational Co$erageDetermination

- +aitin period (efore ICD implantation inpatients .ith cardiomyopathy is 8months after /rst dianosis ofnonischemic cardiomyopathy

- Ho.ever, there are > types of patients.ho present de novo0  $hose .ho have truly de novo

cardiomyopathy and HF

0  $hose .ho have esta(lished cardiomyopathy(ut a de novo presentation of HF

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Decision9Making Process forthe Patient at Risk for SCD

- ACCBAHA uidelines

- ACC appropriateness paper across =68dierent indications

- C#", national coverae determination- Clinical judment

- Patient preference

- Risk manaement

Centers for #edicare and #edicaid "ervices&183

Russo A#, et al.

1273

ipes DP, et al&1223

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HA*9 Home >se of Automated:ternal

De"rillators for SuddenCardiac Arrest

!$erall, 307 patients died• >>; of =@76 patients :6&@?< in the control roup

• >>> of =58@ patients :6&5?< in the A)D roup

87 deaths 60.52

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ength of *ime Patients %orethe %CD

Chun #, et al&1253

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*hank -ou forparticipatingin this acti$it-.

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