MODE OF DEATH IN CHRONIC HEART-FAILURE - A REQUEST AND PROPOSITION FOR MORE ACCURATE CLASSIFICATION

The proportion of patients reported to die suddenly or from progressiv e circulatory failure is not consistent among studies of heart failure . Lack of an adequate or consistent classification of how patients die contributes to the current confusion over the mode of death in heart failure. Defining how patients with heart failure die could be importa nt in developing strategies to reduce the continuing high mortality as sociated with this condition, We identified 37 studies that reported 5 0 or more deaths among patients with heart failure to ascertain how de ath was classified. Definitions of sudden death appeared heterogeneous and the majority of studies failed to publish or make reference to ho w circulatory failure was defined. A framework for the classification of the mode of death has been developed in which clear separation of t he activity and place at the time of death, cause of death, mode of de ath, and events prior to death is made (ACME: Activity, Cause? Mode an d Event). This mode of classifying death has been successfully piloted in two mortality studies, AIRE and NETWORK. Classifying mortality in this way will help identify pathways leading to death and hence sugges t therapies and strategies to reduce mortality in patients with heart failure, a group of patients whose prognosis remains poor.