Accumulation of risk markers predicts the incidence of sudden death in patients with chronic heart failure

Background: Sudden death is common in chronic heart failure (CHF). Risk stratification is the first step for primary prevention. Aim: To evaluate the use of risk markers for estimating sudden death risk. Methods and results: We prospectively examined 680 stable patients with CHF. Risk markers were evaluated using the Cox's proportional hazard model in a stepwise manner. Ejection fraction < 30%, left ventricular end-diastolic diameter > 60 mm, brain natriuretic peptide > 200 pg/ml, non-sustained ventricular tachycardia, and diabetes were significantly associated with increased risk of sudden death. When the number of risk markers were included as co-variables, only "number of risk markers ≥ 3″ entered the model (hazard ratio 8.95, 95% confidence interval 4.57-17.52), while the effects of individual markers did not enter the model. The annual mortality from sudden death was 11% in patients with 3 or more risk markers and 1.4% in patients with 2 or less. Conclusions: Rather than particular risk markers, the number of accumulated risk markers was a more powerful predictor for sudden death in patients with CHF. The number of risk markers could be useful for risk stratification of sudden death.