Objective:

To evaluate longitudinal changes in functional status, health status, and biomarker levels preceding different modes of death in patients with heart failure with mildly reduced or preserved ejection fraction.

Approach:

Key Findings:

• In the 6 months preceding sudden death, NYHA class worsened slightly, symptom scores declined, and natriuretic peptide levels increased.
• Patients who remained alive showed improvement across all measures.
• Patients with heart failure-related death exhibited greater declines in functional status and higher NT-proBNP levels compared to those who died suddenly.
• Sudden death accounts for 25% to 30% of deaths in heart failure with preserved ejection fraction.

Interpretation:

The observed trajectories of worsening functional status and increasing natriuretic peptide levels before sudden death are nonspecific, limiting their clinical actionability for preventive strategies.

Limitations:

• Post hoc design may introduce bias.
• Potential misclassification of deaths.
• Limited measurement of NT-proBNP levels.
• Estimates provided at the population level rather than individual level.

Conclusion:

These trajectories may indicate heightened vulnerability to death, aiding in identifying patients at increased overall risk rather than guiding specific preventive strategies for sudden death.

Sources:

• JAMA Original Investigation
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