A recent study published in the American Journal of Cardiology found that the standards propounded by the American College of Cardiology Foundation with the American Heart Association (ACC/AHA) were superior in predicting which patients would benefit from an implantable cardiac defibrillator (ICD) compared to the calculator set forth by the European Society of Cardiology (ESC). According to the study, the use of the ESC tool will result in more high-risk patients going unprotected against sudden death.
Specifically, the study found that out of a group of 288 HCM patients, 14 who experienced aborted sudden cardiac arrest (or 43%) would not have qualified for an ICD under the ESC risk model compared to 7% of patients under the ACC/AHA guidelines.
The ACC/AHA guidelines are:
A companion editorial by Dr. Andreas S. Barth pointed out the shortcomings of both models, and reaffirmed the necessity for shared decision making between physicians and patients. Dr. Barth also expressed hope that a more accurate predictive model will evolve, though he acknowledged the impossibility of designing a model which could predict future events with certainty.
The HCM Risk–SCD Score
In 2014, the European Society of Cardiology (ESC) introduced a numerical predictor (the “HCM Risk–SCD score”) to assist physicians in identifying those patients at highest risk for sudden cardiac death who would benefit from the implantation of a prophylactic implantable cardioverter-defibrillator.
Using an algorithm generated by the answers to a series of questions, the tool estimates the 5-year risk of sudden cardiac arrest for any particular patient. You can find the tool online here.
Continue reading “A Risk Calculator for Sudden Death -Results of HCM-EVIDENCE Study”
According to research presented at the 2016 European Society of Cardiology Congress today, sudden cardiac arrest from HCM, which has long been thought to result from exercise, is actually more likely to occur at rest, or even during sleep, according to Dr. Gherardo Finocchiaro, a cardiologist at St George’s University in London. Dr. Finocchiaro also pointed out that of the 184 HCM patients in his study, almost 80% had no previous symptoms of HCM, and only 1 in 5 had been diagnosed with HCM before their deaths. Interestingly, most of the sudden deaths from HCM analyzed in the study occurred in patients in their 30s and 40s.
HCM experts in the U.K. have found that extreme left ventricular wall thickness does not automatically correlate with an increased risk of sudden death. Thus, results from a recent study published in the American Heart Association’s Circulation: Arrhythmia and Electrophysiology, suggest that extreme hypertrophy NOT be the sole factor justifying the implantation of an implantable defibrillator.