Static Versus Dynamic Risk of Sudden Cardiac Death: Implications for Improvement of Prediction and Prevention.

Sudden cardiac death (SCD) is a major public health challenge, resulting in significant loss of life each year. Effective prevention relies on identifying individuals at elevated risk; however, accurate prediction of SCD has proven difficult. The current clinical strategy relies on a static risk assessment, primarily using left ventricular ejection fraction (LVEF) < 35% as a key criterion. This approach, however, often falls short. Emerging evidence highlights the potential of dynamic risk assessment to improve SCD risk stratification when changes in vulnerable clinical substrate are monitored over time. These dynamic changes, observed months to years before an event or during the time-period immediately preceding it, have shown promise in enhancing risk prediction. Thus far, relatively few studies have investigated this dynamic risk concept, underscoring the need for further research including validation in larger, prospective studies and clinical trials. Such studies could pave the way for long-term and near-term dynamic risk assessment tools that are independent of, and additive to, static risk stratification, ultimately leading to more accurate and timely identification of patients at risk of SCD.