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8/20/2019 Addressing the Risk for Sudden Cardiac Death in Heart Failure_slides
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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 $rials
)ndpoints Center*riham and +omens Hospital
*oston, #assachusetts
8/20/2019 Addressing the Risk for Sudden Cardiac Death in Heart Failure_slides
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earning !"#ecti$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
8/20/2019 Addressing the Risk for Sudden Cardiac Death in Heart Failure_slides
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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?
8/20/2019 Addressing the Risk for Sudden Cardiac Death in Heart Failure_slides
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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-.
*o proceed to the CMEC
posttest, click the arn CM
Credit link on this page.
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