Clinical Report: Sudden Death Trajectories in HFpEF, HFmrEF

Overview

In patients with heart failure with mildly reduced or preserved ejection fraction, sudden death was preceded by modest worsening in functional status, symptom burden, and natriuretic peptide levels. These patterns limit specificity for sudden death risk, as they were also observed before other modes of death.

Background

Heart failure with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF) represents a growing clinical challenge, as these conditions are associated with significant morbidity and mortality. Sudden death accounts for a substantial proportion of deaths in these populations, yet current guidelines lack effective risk stratification tools for primary prevention. Understanding the trajectories leading to sudden death can inform clinical decision-making and patient management.

Data Highlights

Key Findings

• Sudden death in HFpEF/HFmrEF patients was preceded by a slight worsening in NYHA class and declining symptom scores.
• Patients who remained alive showed improvement in functional status and symptom scores over 18 months.
• Changes in NT-proBNP levels were significant, with increases noted in patients who experienced sudden death.
• Similar patterns were observed in patients who died from heart failure-related causes, indicating a broader vulnerability to death.
• Current guidelines do not recommend implantable cardioverter-defibrillators for primary prevention in these patients due to limitations in risk stratification.

Clinical Implications

Clinicians should be aware that modest declines in functional status and increases in natriuretic peptide levels may indicate heightened vulnerability to death in patients with HFpEF and HFmrEF. While these changes are not specific to sudden death, they may help identify patients at increased overall risk, prompting closer monitoring and potential intervention.

Conclusion

The findings underscore the need for improved risk stratification tools in heart failure patients to better predict sudden death and guide preventive strategies. Understanding these trajectories can enhance patient management and outcomes.

References

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5. 2023 Focused Update of the 2021 ESC Guidelines for Heart Failure, ESC Guidelines
6. Clinical Research in Cardiology — Diagnosis, Risk Evaluation, and Management of Heart Failure with Preserved Ejection Fraction
7. EMPEROR-Preserved Trial Overview, American College of Cardiology
8. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
9. Mode of Death in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The FINEARTS-HF Randomized Clinical Trial - PMC