背景:射血分数降低(HFrEF)和射血分数保留(HFpEF)的心力衰竭研究报告心源性猝死(SCD)发生率高,但推测是心脏原因。潜在原因,指导医学治疗(GDMT),而植入式心律转复除颤器(ICD)在心力衰竭(HF)社区猝死中的应用尚不清楚.
目的:本研究旨在评估HF的负担,GDMT,在POSTSCD(心脏猝死的死后系统调查)研究中尸检猝死中使用ICD,对所有推测的SCD进行的全国性验尸研究。
方法:通过对2011年2月1日至2014年3月1日旧金山县连续院外死亡的前瞻性监测,对18至90岁人群的世卫组织定义(假定)的事件SCD进行了尸检。心律失常性猝死(SAD)没有可识别的非心律失常原因(例如,肺栓塞),因此认为ICD有可能挽救。
结果:在525个假定的SCD中,100(19%)患有HF。有85例已知的HF患者(31例HFpEF,54HFrEF)和15例亚临床HF(无HF诊断的心肌病和肺水肿的死后证据)。SAD占所有假定SCD的56%(525个中的293个),和69%(100个中的69个)的HFSCDs。HFrEF(54个中的40个[74%])和HFpEF(31个中的19个[61%],P=0.45)。四名SAD患者(4%)有ICD,其中3个经历了设备故障。28例SCD的射血分数≤35%:22例(79%)伴有心律失常,6例(21%)伴有非心脏原因。在22名SAD患者中,8人(36%)对ICD转诊没有可识别的障碍。GDMT在HFrEF中的完全运用率为6%。
结论:五分之一的社区猝死有HF;三分之二的人有尸检证实的心律失常原因。ICD预防标准仅占全州所有SAD病例的8%(293个中的22个);GDMT和ICD的使用仍然是HF猝死预防的重要目标。
Studies of heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) report high sudden cardiac death (SCD) rates but presume cardiac cause. Underlying causes,
guideline-directed medical therapy (GDMT), and implantable cardioverter-defibrillator (ICD) use in community sudden deaths with heart failure (HF) are unknown.
This study aims to assess the burden of HF, GDMT, and ICD use among autopsied sudden deaths in the POST SCD (Postmortem Systematic Investigation of Sudden Cardiac Death) study, a countywide postmortem study of all presumed SCDs.
Incident WHO-defined (presumed) SCDs for individuals of ages 18 to 90 years were autopsied via prospective surveillance of consecutive out-of-hospital deaths in San Francisco County from February 1, 2011, to March 1, 2014. Sudden arrhythmic deaths (SADs) had no identifiable nonarrhythmic cause (eg, pulmonary embolism), and are thus considered potentially rescuable with ICD.
Of 525 presumed SCDs, 100 (19%) had HF. There were 85 patients with known HF (31 HFpEF, 54 HFrEF) and 15 with subclinical HF (postmortem evidence of cardiomyopathy and pulmonary edema without HF diagnosis). SADs comprised 56% (293 of 525) of all presumed SCDs, and 69% (69 of 100) of HF SCDs. The rates were similar in HFrEF (40 of 54 [74%]) and HFpEF (19 of 31 [61%], P = 0.45). Four SAD patients (4%) had ICDs, 3 of which experienced device failure. Twenty-eight SCDs had ejection fraction ≤35%: 22 (79%) with arrhythmic and 6 (21%) with noncardiac causes. Of the 22 SAD patients, 8 (36%) had no identifiable barrier to ICD referral. Complete use of GDMT in HFrEF was 6%.
One in 5 community sudden deaths had HF; two-thirds had autopsy-confirmed arrhythmic causes. ICD prevention criteria captured only 8% (22 of 293) of all SAD cases countywide; GDMT and ICD use remain important targets for HF sudden death prevention.