What question did this study set out to answer?

To identify prognostic clinical markers that predict specific modes of death, such as sudden death versus progressive pump failure, in patients with chronic heart failure.

December 13, 2002HeartOpen Access

Mode of death in heart failure: findings from the ATLAS trial

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To identify prognostic clinical markers that predict specific modes of death, such as sudden death versus progressive pump failure, in patients with chronic heart failure.
Randomised, double-blind, parallel-group trial (ATLAS) evaluating 3164 patients with NYHA class II–IV chronic heart failure assigned to high-dose (32.5 or 35 mg) or low-dose (2.5 or 5 mg) daily lisinopril for a median follow-up of 46 months.
Assessed all-cause mortality, cardiovascular mortality, sudden death, and chronic heart failure death using competing risks analysis with independent endpoint committee adjudication.
All-cause and cardiovascular mortality risks were associated with older age, male sex, pre-existing ischaemic heart disease, elevated heart rate, higher creatinine concentration, and specific baseline medications.
Death from chronic heart failure was specifically predicted by low baseline systolic blood pressure, elevated creatinine, reduced serum sodium, lower haemoglobin, and increased heart rate.
Sudden death risk was reduced by baseline use of beta-blockers or antiarrhythmic agents (primarily amiodarone), but was increased with long-acting nitrates and prior angiotensin-converting enzyme inhibitor therapy.

Structured PICO

Population

3164 patients with mild, moderate, or severe chronic heart failure (New York Heart Association functional class II-IV)

Intervention

High dose (32.5 or 35 mg) lisinopril once daily for a median of 46 months

Comparator

Low dose (2.5 or 5 mg) lisinopril once daily

Outcome

All cause mortality, cardiovascular mortality, sudden death, and chronic heart failure death related to prognostic factors using competing risks analysishard clinical

Different clinical variables predict distinct modes of death (sudden death vs. progressive heart failure) in patients with chronic heart failure, which may help tailor specific therapeutic interventions.

Discussion

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Implication

Identifies mode-specific mortality predictors for risk stratification in chronic heart failure; extends competing-risks analysis in large RCTs.

Cite This Study

P A Poole-Wilson (2002) studied this question.

synapsesocial.com/papers/6a869990cbcfc1b71c544b5a https://doi.org/10.1136/heart.89.1.42

Topics

HFrEF treatment Persistent AF management Heart failure Atrial fibrillation Women and heart disease

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Implication

Identifies mode-specific mortality predictors for risk stratification in chronic heart failure; extends competing-risks analysis in large RCTs.

Mode of death in heart failure: findings from the ATLAS trial

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Mode of death in heart failure: findings from the ATLAS trial

Key Points

Structured PICO

Discussion

Implication

Cite This Study

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Topics

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