Predictors of Sudden Cardiac Death

Abstract

SummaryBackground and objectives There are few data on risk factors for sudden cardiac death (SCD) in patients undergoing hemodialysis (HD). The study objective was to identify predictors associated with various causes of death in the Hemodialysis (HEMO) Study and to develop a prediction model for SCD using a competing risk approach.Design, setting, participants, & measurements In this analysis of 1745 HEMO participants, all-cause mortality was classified as SCD, non-SCD, and noncardiac death. Predictors for each cause of death were evaluated using cause-specific Cox proportional hazards models, and a competing risk approach was used to calculate absolute risk predictions for SCD.Results During a median follow-up of 2.5 years, 808 patients died. Rates of SCD, non-SCD, and noncardiac death were 22%, 17%, and 61%, respectively. Predictors of various causes of death differ somewhat in HD patients. Age, diabetes, peripheral vascular disease, ischemic heart disease, serum creatinine, and alkaline phosphatase were independent predictors of SCD. The 3-year C-statistic for SCD was 0.75 (95% confidence interval, 0.70-0.79), and calibration was good (x 2 =1.1; P=0.89). At years 3 and 5 of follow-up, the standard Cox model overestimated the risk for SCD as compared with the competing risk approach on the relative scale by 25% and 46%, respectively, and on the absolute scale by 2% and 6%, respectively.Conclusions Predictors of various causes of death differ in HD patients. The proposed prediction model for SCD accounts for competing causes of death. External validation of this model is required.

Near-Term Prediction of Sudden Cardiac Death in Older Hemodialysis Patients Using Electronic Health Records

“…Cardiac disease accounts for 43% of all-cause mortality, with approximately 61% of those deaths caused by sudden cardiac arrest (SCA) (1). Significant work has been undertaken to understand the epidemiology of and identify risk factors for SCA (2)(3)(4)(5)(6)(7)(8)(9)(10). Many of the risk factors identified, including lower ultrafilitration volume, low calcium dialysate, and shorter treatment time, are readily captured by electronic health record (EHR) systems.…”

“…Some work in this area has occurred, particularly looking at long-term risk (9). However, the assessment of short-term risk is potentially of greater impact, which has become a point of emphasis for the National Heart, Lung, and Blood Institute (NHLBI) (11,12).…”

Alkaline phosphatase is independently associated with renal function in normoalbuminuric type 1 diabetic patients

“…31 In addition, it has been shown that urinary ALK has a potential value in the diagnosis of nephropathy in diabetes, 32 and that ALK was an independent risk factor for cardiac death in subjects with advanced CKD. 33 Moreover, we have previously observed that insulin resistance, the most important antecedent of microalbuminuria, was independently associated with ALK in type 1 diabetes. 27 In multivariate logistic regression analysis, we found that ALK levels tend to be higher in patients with lower serum creatinine levels and in those with higher eGFR, which seems to be contradictory to the previous studies indicating that higher ALK levels are not associated with worsening of renal function.…”

Model Comparisons of Competing Risk and Recurrent Events for Graft Failure in Renal Transplant Recipients

“…We also analyzed death as a competing event, recognizing that death and graft failure share common risk factors, thus limiting the bias inherent in models that censor death in the analysis (5)(6)(7). For the marginal approach, we followed the method of Wei et al (8), which analyzes all recurrent events simultaneously, without conditioning for prior events.…”