Document Detail

Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study.
MedLine Citation:
PMID:  18371559     Owner:  NLM     Status:  MEDLINE    
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).
Brian Olshansky; Jeanne E Poole; George Johnson; Jill Anderson; Anne S Hellkamp; Douglas Packer; Daniel B Mark; Kerry L Lee; Gust H Bardy;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  51     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-28     Completed Date:  2008-04-29     Revised Date:  2008-05-16    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1277-82     Citation Subset:  AIM; IM    
University of Iowa, Iowa City, Iowa, USA.
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MeSH Terms
Amiodarone / therapeutic use*
Anti-Arrhythmia Agents / therapeutic use*
Cardiomyopathies / drug therapy*,  mortality
Death, Sudden, Cardiac* / etiology,  prevention & control
Defibrillators, Implantable
Health Status
Heart Failure / drug therapy*,  mortality
Middle Aged
Myocardial Ischemia / drug therapy*,  mortality
Predictive Value of Tests
Risk Factors
Stroke Volume
Syncope / mortality*
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 1951-25-3/Amiodarone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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