Heart Care Info - Heart Disease Prevention & Treatment

Sudden Cardiac Death Risk Prediction: Commentary on the" Risk Factor and Prediction Modeling for Sudden Cardiac Death in Women With Coronary Artery Disease"

CM Albert - Archives of Internal Medicine, 2011 - Am Med Assoc There have been significant improvements in primary and secondary prevention of congenital heart disease (CHD), resulting in substantial declines in CHD mortality over the last several decades. 1-2 Despite declining CHD mortality rates, the decline in sudden cardiac death ( ...

Presently, primary prevention of SCD relies on risk stratification based on the left ventricular ejection fraction (LVEF) and the degree of congestive heart failure (CHF), followed by implantation of an ICD in patients with an LVEF of less than 35% and New York Heart Association Class II-III CHF. Although clinical trials have demonstrated clear survival benefits conferred by this strategy,5 - 6 there are major limitations to using this approach as the only method for SCD risk stratification. First, most patients who have a cardiac arrest do not have a depressed LVEF documented before SCD,7 and more than 50% of them do not have clinically recognized heart disease.8 - 9 Therefore, this strategy will not affect the vast majority of individuals who will go on to have SCD. Second, the mortality benefit and cost-effectiveness of the ICD are limited by other competing modes of cardiovascular death.10 - 11 Patients with a reduced LVEF and CHF are also at a substantially elevated risk of non-SCD, a limitation that becomes particularly important when the appropriateness of a costly therapy such as the ICD is being considered and for which the time horizon for cost-effectiveness is 5 to 7 years.12 - 14 Therefore, there is a clear need to move beyond the present risk stratification schema based solely on the LVEF and to develop improved markers of arrhythmia risk and preventive strategies that can be applied to broader populations.