Sudden death (SD) is a major threat to survival in patients with end-stage heart failure awaiting cardiac transplantation. Current prioritization of recipient need for transplantation is based on criteria relating to hemodynamic compensation and risk of nonsudden death (NSD). Similar criteria for stratifying risk of SD do not exist and the temporal pattern of SD risk is unknown. We compared actuarial SD and NSD mortality rates in 162 patients listed for transplantation using lifetable analysis. There were 43 (26.5%) cardiac deaths [23(14.2%) sudden and 20(12.3%) nonsudden] during mean followup 15.8 +/- 18.3 months. Hazard functions derived from lifetable analysis were plotted as a function of time and the equations of the best-fit lines were calculated by linear regression (Figure).The slope of the hazard function curve expresses the change in (probability of death/month per month) independent of censored events (transplantation). The SD slope was positive (+0.03 +/- 0.01, R = 0.81, p = 0.04) and the NSD slope was negative (- 0.05 +/- 0.01, Time (months) after listing R = 0.92, p = 0.01) consistent with progressively increasing versus progressively decreasing rates of change in risk, respectively.Conclusions: In patients with end-stage heart failure listed and awaiting transplantation, the risk of NSD decreases over time, while in contrast, the risk of SD increases over time.