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Take the EF and SCA Challenge! Current medical research and guidelines are focusing more attention on ejection fraction as a way to help heart patients and their clinicians make better decisions about their care, particularly heart patients who may be at risk for sudden cardiac arrest (SCA). Test your knowledge about ejection fraction and sudden cardiac arrest. You may be surprised by what you know (or don’t know)! 1. Q: According to the Sudden Cardiac Death in Heart Failure Trial (SCDHeFT), NYHA Class II and III heart failure patients with what EF % are at significant risk for sudden cardiac death? A: a. 50% or less b. 40% or less c. 35% or less d. 15% or less 2. Q: There are approximately five million patients with congestive heart failure in the US2 How much more likely are heart failure patients than the general population to have a sudden cardiac arrest? A: a. 1-2 times b. 4-5 times c. 6-9 times d. 10-15 times 3. Q: What percent of patients who have had a heart attack and have had an echo know their ejection fraction number? A: a. 5% b. 20% c. 45% d. 75% 4. Q: What is the percent of people who have a sudden cardiac arrest in the US and die? A: a. 1% b. 5% c. 50% d. 95% 5. Q: What % of patients with an ICD survive a sudden cardiac arrest? A: a. 50% b. 25% c. 79% d. 98% 200701430EN_Q&A.indd 1 6. Q: Of 1,000 Class II/III, low EF (35% and less) heart failure patients, how many are likely to die over a 5-year period without access to defibrillation (external or internal)? A: a. 22 b. 72 c. 250 d. 553 7. Q: Out of 1,000 heart failure patients, what percent will be NYHA Class II and III with an EF ≤ 35%? A: a. 5% b. 13% c. 32% d. 51% 8. Q: Sudden cardiac death is responsible for a significant number of deaths in the US24, more than stroke, breast cancer and HIV/AIDS combined. How many people die from sudden cardiac death each year? A: a. 150,000 b. 335,000 c. 525,000 d. 1,500,000 9. Q: 80% of all people who die from sudden cardiac death show evidence of what? A: a. Previous coronary artery bypass surgery b. Coronary heart disease c. Congestive heart failure d. Family history of sudden cardiac death 10. Q: A heart patient with which of the following characteristics is at risk for sudden cardiac death? A: a. Coronary artery bypass b. Myocardial infarction c. Heart failure d. Blood relative who has had an SCA e. All of the above 11. Q: What fraction of Class II HF patients die from SCD? A: a. 2/3 b. 1/2 c. 1/4 d. 3/4 12. Q: What percent is considered a LOW ejection fraction? A: a. 75% b. 65% c. 50% d. 35% 13. Q: What percent of patients who are indicated for an ICD actually receive one? A: a. 5% b. 10% c. 20% d. 80% 14. Q: What is the single most important risk factor for overall mortality and sudden cardiac death? A: a. Blood relative dying suddenly b. Previous heart attack c. Reduced LVEF d. Valvular disease 15. Q: In the 2005 ACC/AHA Heart Failure Guidelines, ICD therapy is a Class I indication for which patient? A: a. Survivors of VT/VF b. Previous MI and EF ≤ 35% c. NYHA Class II or III and EF ≤ 35% d. All of the above Answers on back 10/16/06 2:23:08 PM Answers 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. c. 35% or less1 c. 6-9 times2 a. 5%3 d. 95%4-6 d. 98%7 b. 72 heart failure patients1 c. 32%8-11 b. 335,000 die each year from SCD in the US2 b. Coronary heart disease12,13 e. All of the above are risk factors for SCD14-17 a. 2/3 of all Class II HF patients die from sudden cardiac death18 d. For many clinicians, a person with an EF of 35% or less is considered low1 c. 20%19-21 c. Reduced LVEF22 d. All of the above23 References 1 Bardy GH, Lee KL, Mark DB, et al, for the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. January 20, 2005;352(3):225-237. 2 American Heart Association. Heart Disease and Stroke Statistics – 2005 Update. 3 Medtronic data on file. 4 American Heart Association. Statistical fact sheet. “Sudden deaths from cardiac arrest.” Accessed via the Internet on Aug. 1, 2006 at http://www.americanheart.org/presenter.jhtml?identifier=3008699. 5 Pell JP, Sirel JM, Marsden AK, Ford I, Walker NL, Cobbe SM. Presentation, management, and outcome of out of hospital cardiopulmonary arrest: comparison by underlying aetiology. Heart. August 2003;89(8):839-842. 6 de Vreede-Swagemakers JJ, Gorgels AP, Dubois-Arbouw WI, et al. Out-of-hospital cardiac arrest in the 1990s: a population-based study in the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol. November 15,1997;30(6):1500-1505. 7 Zipes DP, Roberts D. Results of the international study of the implantable cardioverter-defibrillator. A comparison of epicardial and endocardial lead systems. The Pacemaker-Cardioverter Defibrillator Investigators. Circulation. July 1, 1995;92(1):59-65. 8 Senni M, Tribouilloy CJ, Rodeheffer RJ, et al. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation. November 24, 1998;98(21): 2282-2289. 9 Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol. June 1999;33(7):1948-1955. 10 Cowie MR, Wood DA, Coats AJ, et al. Incidence and aetiology of heart failure; a population-based study. Euro Heart J. March 1999;20(6):421-428. 11 Havranek EP, Masoudi FA, Westfall KA, Wolfe P, Ordin DL, Krumholz HM. Spectrum of heart failure in older patients: results from the National Heart Failure project. Am Heart J. March 2002;143(3):412-417. 12 Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med. November 15, 2001;345(20):1473-1482. 13 Myerburg RJ. Heart Disease, A Textbook of Cardiovascular Medicine. 6th ed. W.B. Saunders Co., 2001. 14 Demirovic J, Myerburg RJ. Epidemiology of sudden coronary death: an overview. Prog Cardiovasc Dis. July-August 1994;37(1):39-48. 15 Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. March 21, 2002;346(12):877-883. 16 A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators AVID) Investigators. N Engl J Med. November 27, 1997;337(22):1576-1583. 17 Friedlander Y, Siscovick DS, Weinmann S, et al. Family history as a risk factor for primary cardiac arrest. Circulation. January 20, 1998;97(2):155-160. 18 Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. June 12, 1999;353(9169):2001-2007. 19 Ruskin JN, Camm AJ, Zipes DP, et al. J Cardiovasc Electrophysiol. 2002;13(1):38-43. 20 Medtronic internal estimate based on device registration data. 21 Weighted average of Class I and Class IIa penetration estimates. 22 Priori SG, Aliot E, Blomstrom-Lundquist C, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J. August 2001;22(16):1374-1450. 23 ACC/AHA 2005 Guidelines Update for the Diagnosis and Management of Chronic Heart Failure in the Adult. 24 Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation. 2002;104(18):2158-2163. World Headquarters Medtronic, Inc. 710 Medtronic Parkway Minneapolis, MN 55432-5604 USA Tel: (763) 514-4000 Fax: (763) 514-4879 www.medtronic.com Medtronic USA, Inc. Toll-free: 1 (800) 328-2518 (24-hour technical support for physicians and medical professionals) 200701430EN_Q&A.indd 2 UC200701430 EN © Medtronic, Inc. 2006 All Rights Reserved Printed in USA October 2006 10/16/06 2:23:09 PM