Biomarker, Functional Status, and Quality-of-Life Trajectories Before Modes of Death in Heart Failure

Are sudden deaths in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or HF with preserved ejection fraction (HFpEF) preceded by identifiable clinical deterioration compared with other modes of death?In this post hoc analysis of the Finerenone Trial to Investigate the Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) randomized clinical trial including 6001 patients with HFmrEF or HFpEF, sudden death was preceded by modest worsening in New York Heart Association class, substantial declines in patient-reported health status, and rising N-terminal pro–B-type natriuretic peptide levels in the months before death, suggesting that many events may not have been entirely sudden or unexpected. Similar or more pronounced patterns were observed before other cardiovascular and noncardiovascular deaths.Study findings reveal that although sudden death in HFmrEF or HFpEF is often preceded by clinical deterioration—suggesting that many events may not be entirely sudden or unexpected— these clinical signals lack specificity and are unlikely to meaningfully inform targeted prevention strategies.

Corresponding Author: Scott D. Solomon, MD, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (ssolomon@bwh.harvard.edu).

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