TIMING OF SUDDEN-DEATH IN PATIENTS WITH HEART-FAILURE

Objectives, The purpose of this study was to determine the timing of s udden death in patients with advanced heart failure. Background. The f requency of sudden cardiac death and myocardial infarction is greatest in the morning hours, suggesting that physiologic processes associate d,vith morning activities may trigger these events. In patients with a dvanced heart failure, a variety of mechanisms may cause sudden death, and the frequency of their occurrence may differ from that in other p atient groups, perhaps altering the timing of sudden death in heart fa ilure. Methods. Deaths among 566 consecutive patients followed up afte r treatment for advanced heart failure were prospectively categorized as sudden death, death due to heart failure or noncardiac death, For 7 2 sudden deaths the time of death was determined from witnesses to the event and from death certificates. Results. Sudden death occurred 2.5 times more frequently between 6:01 AM and 12 noon than in the three o ther 6-h intervals, with 46% of deaths occurring during this period (p < 0.005). The morning peak occurred both in patients with coronary ar tery disease and in those with nonischemic causes of heart failure. Co nclusions. Despite a variety of potential mechanisms of sudden death a nd underlying causes of heart disease in Patients with heart failure, the 24-h distribution of sudden death in these patients is similar to that observed in other patient groups. Morning surges in sympathetic n ervous system activity may promote a variety of sudden death mechanism s, including ischemic and nonischemic arrhythmias.