Name:
Sudden Cardiac Death in Heart Failure
Description:
Sudden Cardiac Death in Heart Failure
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Duration:
T00H04M13S
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's The Heart Board Review and other online resources available only through accesscardiology.com. >> Sudden cardiac death in patients with heart failure is a devastating event. What do we know about the effect of therapies? Hi, I'm Dr. Bernie, and welcome to Practice Impact Extra. The sudden cardiac death and heart failure trial, the SCD-HeFT trial, was completed in October 2003 and presented in March 2004.
The goal of the trial was to evaluate the effectiveness of amiodarone therapy or an implantable cardioverter-defibrillator, the ICD, to placebo in patients with New York Heart Association Class II and III congestive heart failure. These patients had a reduced ejection fraction of less than 35%. The ICD was programmed only for ventricular fibrillation. So, 2521 patients were randomized and had a median followup of 45.5 months.
What were the results of the original trial? Well, that reported amiodarone compared to placebo did not affect survival. Whereas randomization to an ICD significantly decreased all-cause mortality by 23%. I want to now return to the SCD-HeFT, but the followup study, which was published in July 2020. This reported the extended treatment survival of the SCD-HeFT cohort.
Mortality outcomes with 1855 patients alive at the end of the initial SCD-HeFT trial were collected. The data were combined with the 66 deaths from the original study, and they compared the long-term outcomes, as well as some key pre-specified subgroups. There was a median followup of 11 years, and here are the results. The ICD groups had a significant overall survival benefit versus placebo.
There was no survival difference between amiodarone and placebo. Let's do a look at the breakdown of the treatment benefit, and this was examined as a function of time from randomization. And also, they noted an attenuation of the ICD benefit after 6 years. However, what I wanted to call your attention to, there was a significant 57% crossover to the ICD arm in the 11-year trial.
Further subgroup analysis revealed long-term ICD benefit varied according to heart failure etiology and the New York Heart Classification of heart failure. Ischemic heart failure. Ischemic heart failure had a significant and maintained benefit compared to non-ischemic heart failure. Patients with New York Heart Association Class II had a significant maintained benefit compared to those with New York Heart Association Classification III congestive heart failure.
So, what can we conclude? Followup of the SCD-HeFT patients at 11 years demonstrated heterogeneous treatment-related patterns of long-term survival with ICD benefit were most evident at 11 years for those patients with ischemic heart failure and for those patients with New York Heart Association Class II at trial of enrollment. Again, thanks for joining me, and see you next time on Practice Impact Extra.
>> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features. To subscribe or learn more, please visit accesscardiology.com.
