Heart failure and Sudden death

Syndrome of congestive heart failure is a clinical manifestation of many cardiac disease processes when the cardiovascular compensatory mechanisms are no longer able to maintain homeostasis. Approximately five million people in the United States have heart failure and over 550,000 of patients are diagnosed with heart failure for the first time each year. The Framingham heart study reported 62 and 42 % 5-year survival rates, respectively, for men and women with newly diagnosed congestive heart failure in the early 1970s. These mortality rates were six to seven times higher than that of age-matched general population. Of the total mortality, approximately 40-50 % were sudden deaths. The trending in the incidence and survival with heart failure among 11,311 subjects in the Framingham heart study during a 50-year interval has been updated. Heart failure occurred in 1,075 study participants between 1950 and 1999. The 5-year mortality rate among men declined from 70 % in the period from 1950 to 1969 to 59 % in the period from 1990 to 1999, whereas the respective rates among woman declined from 57 to 45 %. Although the relative declining of mortality is encouraging, likely a result of the better understanding of the disease patho-physiology and improvement of the medical and device therapy, the growing epidemics of heart failure has been increasingly recognized in the United States and around the globe. The topic of heart failure and sudden death is enormously broad. Many specific and related topics are discussed in other chapters of the book. In this chapter, we will provide an overview on the following relevant issues: (1) mode of death in patients with heart failure; (2) arrhythmogenic substrates and triggers of malignant arrhythmias causing sudden death; (3) risk stratification schemes in identifying patients at increased risk of sudden death in heart failure; (4) outcomes from sudden death prevention clinical trials; and (5) a summary of current clinical management in sudden death prevention in heart failure.