Ventricular Arrhythmias Among Patients With Advanced Heart Failure: A Population-Based Study

BACKGROUND: The epidemiology of ventricular arrhythmias (VAs) in patients with advanced heart failure (HF) is not well defined. METHODS AND RESULTS: Residents of Olmsted County, Minnesota, with advanced HF from 2007 to 2017 were identified using the 2018 European Society of Cardiology criteria. Billing codes were used to capture VAs; severe VAs requiring emergency care were defined as events associated with emergency department visits or hospitalizations. The cumulative incidence of VAs postadvanced HF was estimated with the Kaplan– Meier method. Multivariable Cox analyses were used to determine the following: (1) Predictors of severe VAs postadvanced HF; and (2) Impact of severe VAs on mortality. Of 936 patients with advanced HF, 261 (27.9%) had a history of VA. The 1-year cumulative incidence of severe VAs postadvanced HF was 5.4%. Prior VAs (hazard ratio [HR] 2.22 [95% CI, 1.26– 3.89], P=0.006) and left ventricular ejection fraction <40% (HR, 3.79 [95% CI, 1.72–8.39], P<0.001) were independently associated with increased severe VA risk postadvanced HF. New-onset severe VAs were associated with increased mortality (HR, 4.41 [95% CI, 2.80– 6.94]; P<0.001), whereas severe VAs in patients with prior VAs had no significant association with mortality risk (HR, 1.08 [95% CI, 0.65–1.78]; P=0.77). Severe VAs were associated with increased mortality in patients without implantable cardioverter defibrillators (HR, 4.89 [95% CI, 2.89– 8.26]; P<0.001), but not in patients with implantable cardioverter defibrillators (HR, 1.42 [95% CI, 0.92– 2.19]; P=0.11). CONCLUSIONS: Patients with left ventricular ejection fraction <40% and prior VAs have increased risk of severe VA postad-vanced HF. New-onset severe VAs or severe VAs without implantable cardioverter defibrillators postadvanced HF are associated with increased mortality.