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Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study.
J Am Coll Cardiol. 2008 Apr 01; 51(13):1277-82.JACC

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 >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).

Authors+Show Affiliations

University of Iowa, Iowa City, Iowa, USA. brian-olshansky@uiowa.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

18371559

Citation

Olshansky, Brian, et al. "Syncope Predicts the Outcome of Cardiomyopathy Patients: Analysis of the SCD-HeFT Study." Journal of the American College of Cardiology, vol. 51, no. 13, 2008, pp. 1277-82.
Olshansky B, Poole JE, Johnson G, et al. Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study. J Am Coll Cardiol. 2008;51(13):1277-82.
Olshansky, B., Poole, J. E., Johnson, G., Anderson, J., Hellkamp, A. S., Packer, D., Mark, D. B., Lee, K. L., & Bardy, G. H. (2008). Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study. Journal of the American College of Cardiology, 51(13), 1277-82. https://doi.org/10.1016/j.jacc.2007.11.065
Olshansky B, 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. PubMed PMID: 18371559.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study. AU - Olshansky,Brian, AU - Poole,Jeanne E, AU - Johnson,George, AU - Anderson,Jill, AU - Hellkamp,Anne S, AU - Packer,Douglas, AU - Mark,Daniel B, AU - Lee,Kerry L, AU - Bardy,Gust H, AU - ,, PY - 2007/08/10/received PY - 2007/10/29/revised PY - 2007/11/21/accepted PY - 2008/3/29/pubmed PY - 2008/4/30/medline PY - 2008/3/29/entrez SP - 1277 EP - 82 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 51 IS - 13 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 >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). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/18371559/Syncope_predicts_the_outcome_of_cardiomyopathy_patients:_analysis_of_the_SCD_HeFT_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)00261-1 DB - PRIME DP - Unbound Medicine ER -