Elsevier

American Heart Journal

Volume 165, Issue 3, March 2013, Pages 379-385.e2
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Incidence of heart failure and mortality after acute coronary syndromes

https://doi.org/10.1016/j.ahj.2012.12.005Get rights and content

Background

The long-term incidence of heart failure (HF) in ST-elevation myocardial infarction (STEMI), non–ST-elevation myocardial infarction (NSTEMI), or unstable angina (UA) patients is uncertain. We examined the 1-year incidence of HF and its association with mortality among patients surviving their first acute coronary syndrome (ACS) hospitalization.

Methods and results

A retrospective cohort study of patients, aged ≥20 years, with no prior HF, hospitalized for the first time with ACS between April 1, 2002, and December 31, 2008, in Alberta, Canada, and followed up for 1 year. Index HF was defined as HF that developed as a complication during the index ACS hospitalization, and post-discharge HF, as HF developing after discharge from the index ACS hospitalization.

Among 9,406 STEMI, 11,008 NSTEMI, and 4,910 UA patients, 13.6%, 14.8%, and 5.2% had index HF, respectively (P < .01). At 1-year, cumulative HF rates were 23.4% in STEMI, 25.4% in NSTEMI, and 16% in UA patients. Among hospital survivors, 1-year mortality rate was 13.9% in patients with index HF, 10.6% in patients with postdischarge HF, and 2.4% in patients with no HF. In multivariable analysis, both index HF (adjusted hazard ratio 3.2, 95% CI 2.7-3.7) and postdischarge HF (adjusted hazard ratio 4.6, 95% CI 3.9-5.4) were associated with 1-year mortality.

Conclusions

There are significant differences in the incidence of HF among STEMI, NSTEMI, and UA patients. The increased mortality risk associated with index HF and postdischarge HF suggests a need for vigilant follow-up of all ACS patients for prompt detection and treatment of HF.

Section snippets

Study population

Our study cohort consists of all residents of Alberta aged 20 years or older hospitalized at an acute care facility with a primary diagnosis of ACS between April 1, 2002, and December 31, 2008 (subsequently referred to as the index hospitalization). For transfer patients, the index hospitalization refers to the index episode and includes concurrent hospitalizations occurring with 24 hours of each other. The diagnosis of ACS is based on International Statistical Classification of Diseases, 10th

Results

A total of 31,469 patients had an acute care hospitalization for ACS between April 1, 2002, and December 31, 2008 (Figure 1). Patients with prior ACS (n = 4,988, 15.9%) or with prior HF (n = 2,492, 7.9%) were excluded from the cohort. The final study population consisted of 9,406 (37.1%) STEMI, 11,008 (43.5%) NSTEMI, and 4,910 (19.4%) UA patients. ST-elevation myocardial infarction patients were younger, less likely to be female, and generally had lower rates of comorbid disease relative to

Discussion

In this population-level analysis of 25,324 patients hospitalized for the first time with ACS between 2002 and 2008, there were significant differences in HF developing both during (index HF) and after discharge from the index ACS hospitalization (postdischarge HF) across the 3 ACS subtypes (STEMI, NSTEMI, and UA). Among patients who survived the index ACS hospitalization, both index HF and postdischarge HF were associated with a higher 1-year mortality risk, although the magnitude of the

Conclusion

In a population-level cohort of patients hospitalized for the first time with an ACS event, there were significant differences in the long-term incidence of HF among STEMI, NSTEMI, and UA patients. Among hospital survivors, HF developed either during the ACS hospitalization or after discharge confers a substantial risk of death during the first year. The downstream morbidity and mortality associated with HF suggest a need for increased surveillance and timely diagnosis and treatment among all

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