Editorial: Sudden death in heart failure: an ounce of prediction is worth a pound of prevention.

摘要

Sudden cardiac death (SCD) is not only a clinical problem that is extraordinarily frightening for patients and their families but also a major and costly public health burden. Nearly 450,000 individuals die of SCD every year in the United States, and SCD claims more lives every year in the United States than stroke, lung cancer, breast cancer, and AIDS combined. Unfortunately, there are few discernible risk factors in most patients with SCD. However, left ventricular (LV) systolic dysfunction, particularly because of coronary artery disease (CAD), identifies a group at particularly high risk of SCD. The incidence of sudden death in patients with LV ejection fraction (LVEF) less than 0.30 is more than 15%. In the Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) study, the proportion of sudden death was highest in relatively asymptomatic patients, that is, New York Heart Association (NYHA) class II patients, and sudden deaths generally decreased with increasing severity of heart failure according to the NYHA functional class (Fig. 1), suggesting that the therapies targeted early in the course of the disease should get the "biggest bang for the buck".