Syncope Predicts the Outcome of Cardiomyopathy Patients. Analysis of the SCD-HeFT Study

Brian Olshansky, Jeanne E. Poole, George Johnson, Jill Anderson, Anne S. Hellkamp, Douglas L Packer, Daniel B. Mark, Kerry L. Lee, Gust H. Bardy

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Abstract

Objectives: The outcome of congestive heart failure (CHF) patients with syncope is understood incompletely. Background: We analyzed data from patients enrolled in the SCD-HeFT (Sudden Cardiac Death Heart Failure Trial) to determine whether syncope predicted outcomes in patients with CHF. Methods: We compared outcomes (and associated clinical characteristics) in patients with and without syncope enrolled in SCD-HeFT. Results: In SCD-HeFT, 162 (6%) patients had syncope before randomization, 356 (14%) had syncope after randomization (similar incidence in each randomized arm), and 46 (2%) had syncope before and after randomization. A QRS duration ≥120 ms and absence of beta-blocker use predicted syncope during follow-up (hazard ratio [HR] 1.30 and 95% confidence interval [CI] 1.06 to 1.61, p = 0.014 and HR 1.25, 95% CI 1.01 to 1.56, p = 0.048, respectively). Syncope recurrence did not differ by randomization arm. However, in the implantable cardioverter-defibrillator (ICD) arm, syncope, before and after randomization, was associated with appropriate ICD discharges (HR 1.75, 95% CI 1.10 to 2.80, p = 0.019 and HR 2.91, 95% CI 1.89 to 4.47, p = 0.001, respectively). Post-randomization syncope predicted total and cardiovascular death (HR 1.41, 95% CI 1.13 to 1.76, p = 0.002 and HR 1.55, 95% CI 1.19 to 2.02, p = 0.001, respectively). The elevated relative risk of mortality for syncope versus nonsyncope patients did not vary significantly across treatment arms (ICD, HR 1.54, 95% CI 1.04 to 2.27; amiodarone, HR 1.33, 95% CI 0.91 to 1.93; and placebo, HR 1.39, 95% CI 0.96 to 2.02, test for difference p = 0.86). Conclusions: For CHF patients with ICDs, syncope was associated with appropriate ICD activations. Syncope was associated with increased mortality risk in SCD-HeFT regardless of treatment arm (placebo, amiodarone, or ICD). (SCD-HeFT Trial; NCT00000609).

Original languageEnglish (US)
Pages (from-to)1277-1282
Number of pages6
JournalJournal of the American College of Cardiology
Volume51
Issue number13
DOIs
StatePublished - Apr 1 2008

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Sudden Cardiac Death
Syncope
Cardiomyopathies
Heart Failure
Confidence Intervals
Random Allocation
Implantable Defibrillators
Amiodarone
Placebos
Mortality

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Syncope Predicts the Outcome of Cardiomyopathy Patients. Analysis of the SCD-HeFT Study. / Olshansky, Brian; Poole, Jeanne E.; Johnson, George; Anderson, Jill; Hellkamp, Anne S.; Packer, Douglas L; Mark, Daniel B.; Lee, Kerry L.; Bardy, Gust H.

In: Journal of the American College of Cardiology, Vol. 51, No. 13, 01.04.2008, p. 1277-1282.

Research output: Contribution to journalArticle

Olshansky, B, Poole, JE, Johnson, G, Anderson, J, Hellkamp, AS, Packer, DL, Mark, DB, Lee, KL & Bardy, GH 2008, 'Syncope Predicts the Outcome of Cardiomyopathy Patients. Analysis of the SCD-HeFT Study', Journal of the American College of Cardiology, vol. 51, no. 13, pp. 1277-1282. https://doi.org/10.1016/j.jacc.2007.11.065
Olshansky, Brian ; Poole, Jeanne E. ; Johnson, George ; Anderson, Jill ; Hellkamp, Anne S. ; Packer, Douglas L ; Mark, Daniel B. ; Lee, Kerry L. ; Bardy, Gust H. / Syncope Predicts the Outcome of Cardiomyopathy Patients. Analysis of the SCD-HeFT Study. In: Journal of the American College of Cardiology. 2008 ; Vol. 51, No. 13. pp. 1277-1282.
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abstract = "Objectives: The outcome of congestive heart failure (CHF) patients with syncope is understood incompletely. Background: We analyzed data from patients enrolled in the SCD-HeFT (Sudden Cardiac Death Heart Failure Trial) to determine whether syncope predicted outcomes in patients with CHF. Methods: We compared outcomes (and associated clinical characteristics) in patients with and without syncope enrolled in SCD-HeFT. Results: In SCD-HeFT, 162 (6{\%}) patients had syncope before randomization, 356 (14{\%}) had syncope after randomization (similar incidence in each randomized arm), and 46 (2{\%}) had syncope before and after randomization. A QRS duration ≥120 ms and absence of beta-blocker use predicted syncope during follow-up (hazard ratio [HR] 1.30 and 95{\%} confidence interval [CI] 1.06 to 1.61, p = 0.014 and HR 1.25, 95{\%} CI 1.01 to 1.56, p = 0.048, respectively). Syncope recurrence did not differ by randomization arm. However, in the implantable cardioverter-defibrillator (ICD) arm, syncope, before and after randomization, was associated with appropriate ICD discharges (HR 1.75, 95{\%} CI 1.10 to 2.80, p = 0.019 and HR 2.91, 95{\%} CI 1.89 to 4.47, p = 0.001, respectively). Post-randomization syncope predicted total and cardiovascular death (HR 1.41, 95{\%} CI 1.13 to 1.76, p = 0.002 and HR 1.55, 95{\%} CI 1.19 to 2.02, p = 0.001, respectively). The elevated relative risk of mortality for syncope versus nonsyncope patients did not vary significantly across treatment arms (ICD, HR 1.54, 95{\%} CI 1.04 to 2.27; amiodarone, HR 1.33, 95{\%} CI 0.91 to 1.93; and placebo, HR 1.39, 95{\%} CI 0.96 to 2.02, test for difference p = 0.86). Conclusions: For CHF patients with ICDs, syncope was associated with appropriate ICD activations. Syncope was associated with increased mortality risk in SCD-HeFT regardless of treatment arm (placebo, amiodarone, or ICD). (SCD-HeFT Trial; NCT00000609).",
author = "Brian Olshansky and Poole, {Jeanne E.} and George Johnson and Jill Anderson and Hellkamp, {Anne S.} and Packer, {Douglas L} and Mark, {Daniel B.} and Lee, {Kerry L.} and Bardy, {Gust H.}",
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AU - Olshansky, Brian

AU - Poole, Jeanne E.

AU - Johnson, George

AU - Anderson, Jill

AU - Hellkamp, Anne S.

AU - Packer, Douglas L

AU - Mark, Daniel B.

AU - Lee, Kerry L.

AU - Bardy, Gust H.

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N2 - Objectives: The outcome of congestive heart failure (CHF) patients with syncope is understood incompletely. Background: We analyzed data from patients enrolled in the SCD-HeFT (Sudden Cardiac Death Heart Failure Trial) to determine whether syncope predicted outcomes in patients with CHF. Methods: We compared outcomes (and associated clinical characteristics) in patients with and without syncope enrolled in SCD-HeFT. Results: In SCD-HeFT, 162 (6%) patients had syncope before randomization, 356 (14%) had syncope after randomization (similar incidence in each randomized arm), and 46 (2%) had syncope before and after randomization. A QRS duration ≥120 ms and absence of beta-blocker use predicted syncope during follow-up (hazard ratio [HR] 1.30 and 95% confidence interval [CI] 1.06 to 1.61, p = 0.014 and HR 1.25, 95% CI 1.01 to 1.56, p = 0.048, respectively). Syncope recurrence did not differ by randomization arm. However, in the implantable cardioverter-defibrillator (ICD) arm, syncope, before and after randomization, was associated with appropriate ICD discharges (HR 1.75, 95% CI 1.10 to 2.80, p = 0.019 and HR 2.91, 95% CI 1.89 to 4.47, p = 0.001, respectively). Post-randomization syncope predicted total and cardiovascular death (HR 1.41, 95% CI 1.13 to 1.76, p = 0.002 and HR 1.55, 95% CI 1.19 to 2.02, p = 0.001, respectively). The elevated relative risk of mortality for syncope versus nonsyncope patients did not vary significantly across treatment arms (ICD, HR 1.54, 95% CI 1.04 to 2.27; amiodarone, HR 1.33, 95% CI 0.91 to 1.93; and placebo, HR 1.39, 95% CI 0.96 to 2.02, test for difference p = 0.86). Conclusions: For CHF patients with ICDs, syncope was associated with appropriate ICD activations. Syncope was associated with increased mortality risk in SCD-HeFT regardless of treatment arm (placebo, amiodarone, or ICD). (SCD-HeFT Trial; NCT00000609).

AB - Objectives: The outcome of congestive heart failure (CHF) patients with syncope is understood incompletely. Background: We analyzed data from patients enrolled in the SCD-HeFT (Sudden Cardiac Death Heart Failure Trial) to determine whether syncope predicted outcomes in patients with CHF. Methods: We compared outcomes (and associated clinical characteristics) in patients with and without syncope enrolled in SCD-HeFT. Results: In SCD-HeFT, 162 (6%) patients had syncope before randomization, 356 (14%) had syncope after randomization (similar incidence in each randomized arm), and 46 (2%) had syncope before and after randomization. A QRS duration ≥120 ms and absence of beta-blocker use predicted syncope during follow-up (hazard ratio [HR] 1.30 and 95% confidence interval [CI] 1.06 to 1.61, p = 0.014 and HR 1.25, 95% CI 1.01 to 1.56, p = 0.048, respectively). Syncope recurrence did not differ by randomization arm. However, in the implantable cardioverter-defibrillator (ICD) arm, syncope, before and after randomization, was associated with appropriate ICD discharges (HR 1.75, 95% CI 1.10 to 2.80, p = 0.019 and HR 2.91, 95% CI 1.89 to 4.47, p = 0.001, respectively). Post-randomization syncope predicted total and cardiovascular death (HR 1.41, 95% CI 1.13 to 1.76, p = 0.002 and HR 1.55, 95% CI 1.19 to 2.02, p = 0.001, respectively). The elevated relative risk of mortality for syncope versus nonsyncope patients did not vary significantly across treatment arms (ICD, HR 1.54, 95% CI 1.04 to 2.27; amiodarone, HR 1.33, 95% CI 0.91 to 1.93; and placebo, HR 1.39, 95% CI 0.96 to 2.02, test for difference p = 0.86). Conclusions: For CHF patients with ICDs, syncope was associated with appropriate ICD activations. Syncope was associated with increased mortality risk in SCD-HeFT regardless of treatment arm (placebo, amiodarone, or ICD). (SCD-HeFT Trial; NCT00000609).

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