Background:Patients with nonischemic systolic heart failure (HF) have increased risk of sudden cardiac death (SCD) and death from progressive pump failure. Whether the risk of SCD changes over time is unknown. We seek here to investigate the relation between duration of HF, mode of death, and effect of implantable cardioverter-defibrillator implantation.Methods and Results:We examined the risk of all-cause death and SCD according to the duration of HF among patients with nonischemic systolic HF enrolled in the DANISH (Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality). In all, 1116 patients were included. Patients were divided according to quartiles of HF duration (≤8, 9≤18, 19≤65, and ≥66 months). Patients with the longest duration of HF were older, more often men, had more comorbidity, and more often received a cardiac resynchronization therapy device. Doubling of HF duration was an independent predictor of both all-cause mortality (hazard ratio [HR], 1.27; 95% CI, 1.17–1.38; P<0.0001), and SCD (HR, 1.29; 95% CI, 1.11–1.50; P=0.0007). The proportion of deaths caused by SCD was not different between HF quartiles (P=0.91), and the effect of implantable cardioverter-defibrillator implantation on all-cause mortality was not modified by the duration of HF (P=0.59).Conclusions:Duration of HF predicted both all-cause mortality and risk of SCD independently of other risk indicators. However, the proportion of death caused by SCD did not change with longer duration of HF, and the effect of implantable cardioverter-defibrillator was not modified by the duration of HF.Clinical Trial Registration:URL: https://www.clinicaltrials.gov. Unique identifier: NCT00542945.

中文翻译：

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非缺血性收缩期心力衰竭患者的心力衰竭持续时间和除颤器植入的效果。

背景：患有非缺血性收缩期心力衰竭（HF）的患者发生心脏猝死（SCD）和进行性泵衰竭致死的风险增加。SCD的风险是否随时间变化尚不清楚。方法和结果：我们根据非缺血性患者的HF持续时间，检查了全因死亡和SCD的风险。收缩期HF入选DANISH（丹麦研究，旨在评估ICD对非缺血性收缩期心力衰竭患者死亡率的有效性）。总共包括1116例患者。根据HF持续时间的四分位数（≤8、9≤18、19≤65和≥66个月）对患者进行划分。HF持续时间最长的患者年龄较大，男性较多，合并症更多，并且更经常接受心脏再同步治疗仪。HF持续时间加倍是两种全因死亡率的独立预测因子（危险比[HR]为1.27； 95％CI为1.17-1.38；P <0.0001）和SCD（HR，1.29； 95％CI，1.11-1.50；P = 0.0007）。在HF四分位数之间，由SCD引起的死亡比例没有差异（P = 0.91），而HF持续时间并未改变植入式心脏复律除颤器植入对全因死亡率的影响（P = 0.59）。 HF的预测独立于其他风险指标，既可以预测全因死亡率，也可以预测SCD的风险。然而，随着心衰持续时间的延长，由SCD引起的死亡比例没有改变，并且心律失常的持续时间并未改变植入式心脏复律除颤器的效果。临床试验注册：URL：https://www.clinicaltrials.gov 。唯一标识符：NCT00542945。