Patients who develop heart failure (HF) after an acute myocardial infarction (AMI)
are at higher risk of adverse fatal and nonfatal outcomes. Published studies on the
incidence and associations of HF after infarction have been contradictory, with some
reporting increasing and others decreasing incidence. Between 2000 and 2015, 109,717
patients admitted for a first AMI in New Jersey were discharged alive. In the 15 years
from 2000 to 2015, the rates of admission for HF in AMI patients who were discharged
alive decreased by 60%, from 3.48% to 1.4%, at 1-year follow-up. At 5 years of follow-up,
the decline was more pronounced, from 7.21% to 1.4%, an 80% decline. All-cause death,
and the combined end point of admission for HF or death, showed decreasing trends.
Cox regression indicated a decrease in the risk of admission for HF over time (hazard
ratio [HR] 0.955, 95% confidence interval [CI] 0.949 to 0.961). Younger age, male
gender, and commercial insurance were associated with lower HRs for HF (p <0.001),
whereas history of hypertension, diabetes, kidney, or lung disease were associated
with higher HRs (p <0.001). There was no significant difference in the rate of HF
between subendocardial and transmural AMI (adjusted OR was 0.96, CI 0.90 to 1.03,
p = 0.241). Revascularization was associated with a marked decrease in HF admissions
(adjusted OR 0.22, 95% CI 0.19 to 0.25, p <0.001 for percutaneous coronary intervention
and OR 0.44, 95% CI 0.38 to 0.51, p <0.001 for CABG). In conclusion, the rate of admission
for HF after discharge for a first myocardial infarction as well as all-cause death
decreased markedly from 2000 to 2015.
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Article info
Publication history
Published online: March 28, 2018
Accepted:
March 13,
2018
Received:
January 8,
2018
Footnotes
See page 4 for disclosure information.
This study was funded, in part, by the Robert Wood Johnson Foundation (Princeton, NJ).
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
