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Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study.

Publication ,  Journal Article
Olshansky, B; Poole, JE; Johnson, G; Anderson, J; Hellkamp, AS; Packer, D; Mark, DB; Lee, KL; Bardy, GH; SCD-HeFT Investigators,
Published in: J Am Coll Cardiol
April 1, 2008

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 >or=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 non-syncope 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).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

April 1, 2008

Volume

51

Issue

13

Start / End Page

1277 / 1282

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Syncope
  • Stroke Volume
  • Risk Factors
  • Risk
  • Recurrence
  • Prognosis
  • Predictive Value of Tests
  • Myocardial Ischemia
 

Citation

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Olshansky, B., Poole, J. E., Johnson, G., Anderson, J., Hellkamp, A. S., Packer, D., … SCD-HeFT Investigators, . (2008). Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study. J Am Coll Cardiol, 51(13), 1277–1282. https://doi.org/10.1016/j.jacc.2007.11.065
Olshansky, Brian, Jeanne E. Poole, George Johnson, Jill Anderson, Anne S. Hellkamp, Douglas Packer, Daniel B. Mark, Kerry L. Lee, Gust H. Bardy, and Gust H. SCD-HeFT Investigators. “Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study.J Am Coll Cardiol 51, no. 13 (April 1, 2008): 1277–82. https://doi.org/10.1016/j.jacc.2007.11.065.
Olshansky B, Poole JE, Johnson G, Anderson J, Hellkamp AS, Packer D, et al. Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study. J Am Coll Cardiol. 2008 Apr 1;51(13):1277–82.
Olshansky, Brian, et al. “Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study.J Am Coll Cardiol, vol. 51, no. 13, Apr. 2008, pp. 1277–82. Pubmed, doi:10.1016/j.jacc.2007.11.065.
Olshansky B, Poole JE, Johnson G, Anderson J, Hellkamp AS, Packer D, Mark DB, Lee KL, Bardy GH, SCD-HeFT Investigators. Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study. J Am Coll Cardiol. 2008 Apr 1;51(13):1277–1282.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

April 1, 2008

Volume

51

Issue

13

Start / End Page

1277 / 1282

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Syncope
  • Stroke Volume
  • Risk Factors
  • Risk
  • Recurrence
  • Prognosis
  • Predictive Value of Tests
  • Myocardial Ischemia