Abstract 18143: Sudden Death in Heart Failure (HF) With Preserved Ejection Fraction: Clinical Profile and Role of Atrial Fibrillation (AF) and HF NYHA Class

Abstract

Introduction: Clinical risk factors for sudden death(SD) in patients with HFpEF have not been hitherto well characterized nor is the impact of concomitant atrial fibrillation (AF) on SD risk in HFpEF defined. Methods: We evaluated 1765 HFpEF subjects from the TOPCAT Americas trial to identify potential clinical markers for SD risk. We also examined the role of AF presentation, comparing pts in sinus rhythm (SR, n=1319) to pts in AF at study entry with two different AF presentations (Any AF or AF on baseline ECG) during a mean follow up period of 2.9 years. Results: AF on baseline ECG was independently associated with excess CV mortality (HR 1.46, 95% CI 1.10-1.95, P = 0.009). SD occurred in 77 pts (4.4%) of all HFpEF subjects. 20 SD victims had concomitant AF on baseline ECG (26 % of all SD). SD events were significantly more frequent in males (p=.002), in black or other minority ethnicity (vs. white; p<0.001), diabetics (p=0.024), lower eGFR (p=0.035) and vascular disease (p=0.044). Multivariate Cox analysis identified significant increased SD risk in people with reduced eGFR (HR 0.98, CI: 0.97 to 1.00, p=0.005), reduced risk in females (HR 0.40, 95% CI 0.24,0.65, p<0.001) and increased risk in smokers (HR: 2.16, 95% CI: 1.03 to 4.54, p=0.042). In unmatched or propensity score matched cohorts, neither Any AF or AF on ECG was independently associated with increased SD risk (Figure; p>0.2). SD risk was also similar in early and advanced NYHA class HF. Conclusions: 1. SD risk in HFpEF is influenced by gender, race, lifestyle and systemic comorbidities. 2. In contrast to HF with reduced EF, SD risk is not impacted by concomitant AF, its presentation or HF NYHA class.