Predictors and Outcomes of Sudden Cardiac Arrest in Heart Failure With Preserved Ejection Fraction: A Nationwide Inpatient Sample Analysis

Sudden cardiac arrest (SCA) is the leading cause of cardiovascular mortality in heart failure with preserved ejection fraction (HFpEF), contributing to around 25% of deaths observed in pivotal HFpEF trials. However, predictors and outcomes of in-hospital SCA in HFpEF have not been well characterized...

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Bibliographic Details
Published in:The American journal of cardiology 2023-11, Vol.206, p.277-284
Main Authors: Garg, Mohil, Gupta, Mohak, Patel, Neel N., Bansal, Kannu, Lam, Phillip H., Sheikh, Farooq H.
Format: Article
Language:English
Subjects:
Cardiac arrest
Cardiac arrhythmia
Cardiovascular disease
Cardiovascular diseases
Chronic conditions
Clinical trials
Complications
Congestive heart failure
Disease prevention
Ejection fraction
Embolism
Heart failure
HFpEF
Hospitalization
Hospitals
Hypertension
in-hospital outcomes
Independent variables
Kidney diseases
Liver diseases
Morbidity
Mortality
Myocardial infarction
Pacemakers
predictors
Regression analysis
Risk factors
Sarcoidosis
Statistical analysis
sudden cardiac arrest
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Summary:Sudden cardiac arrest (SCA) is the leading cause of cardiovascular mortality in heart failure with preserved ejection fraction (HFpEF), contributing to around 25% of deaths observed in pivotal HFpEF trials. However, predictors and outcomes of in-hospital SCA in HFpEF have not been well characterized. We queried the Nationwide Inpatient Sample (2016 to 2017) to identify adult hospitalizations with a diagnosis of HFpEF. Patients with acute or chronic conditions associated with SCA (e.g., acute myocardial infarction, acute pulmonary embolism, sarcoidosis) were excluded. We ascertained whether SCA occurred during these hospitalizations, identified predictors of SCA using multivariate logistic regression, and determined outcomes of SCA in HFpEF. Of 2,909,134 hospitalizations, SCA occurred in 1.48% (43,105). The mean age of the SCA group was 72.3 ± 12.4 years, 55.8% were women, and 66.4% were White. Presence of third-degree atrioventricular block (odds ratio [OR] 5.95, 95% confidence interval [CI] 5.31 to 6.67), left bundle branch block (OR 1.96, 95% CI 1.72 to 2.25), and liver disease (OR 1.87, 95% CI 1.73 to 2.02) were the leading predictors of SCA in HFpEF. After excluding patients with do-not-resuscitate status, the SCA group versus those without SCA had higher mortality (25.9% vs 1.6%), major bleeding complications (4.1% vs 1.7%), increased use of percutaneous coronary intervention (2.5% vs 0.7%), and mechanical circulatory assist device (1.2% vs 0.1%). These observational inpatient data suggest identifiable risk factors for SCA in HFpEF including cardiac arrhythmias. Further research is warranted to identify the best tools to risk-stratify patients with HFpEF to implement targeted SCA prevention strategies.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2023.08.145