AHA/ACC Guidelines to primary prevention of Sudden Cardiac Death
Sudden Cardiac Death (SCD) accounts for over half of cardiovascular mortality and is a major public health issue. The American Heart Association (AHA) and the Americal College of Cardiology (ACC) have released a guideline on primary prevention and control of SCDs in early and post Myocardial Infarction (MI).
The guideline aims at providing a contemporary guideline for the management of adults who have Ventricular Arrhythmia (VA) or who are at risk for SCD, including diseases and syndromes associated with a risk of SCD from VA.
Sudden cardiac death (SCD) is generally understood by the lay and medical communities as sudden unexpected collapse, without warning. Survival after SCD remains very low and stable, despite major investments by the medical and research communities in this area over the past decades.
Ventricular Arrhythmia (VA) includes a spectrum of disease that ranges from the premature ventricular complex (PVC) to ventricular fibrillation (VF), with a clinical presentation that ranges from a total lack of symptoms to cardiac arrest. Most life-threatening VAs are associated with ischemic heart disease which is particularly seen in older patients.
The risks of VA and SCD vary in specific populations with different underlying cardiac conditions, and with specific family history and genetic variants, and this variation has important implications for studying and applying therapies.
The present guideline is an updated version of the previous guideline. It outlines the key recommendations, changes from previous guidelines, and patient benefits.
Following are the key recommendation of the guideline provided for primary prevention and control of SCD in patients with ventricular arrhythmia.
- With reduced EF (<40%), follow guideline-directed medical therapy (GDMT), to include:
- Mineralocorticoid receptor antagonists; and
- Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors.
- With life expectancy >1 year, where GDMT fails to prevent the following, implanted cardioverter defibrillator (ICD) is recommended:
- Left ventricular EF (LVEF) ≤35% and ischemic heart disease at 40+ days after myocardial infarction, 90+ days post-revascularization, class II-III heart failure;
- LVEF ≤30% with ischemic heart disease at 40+ days after myocardial infarction, 90+ days post-revascularization, class I heart failure; or
- Nonischemic cardiomyopathy, class II-III symptoms, LVEF ≤35%.
- Biggest guidelines change from earlier versions is the addition of angiotensin receptor-neprilysin inhibitors, which the synopsis authors say remains controversial.
- Benefits for patients include the focus on GDMT before moving to ICD, with the parameter of expected survival >1 year.
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