© 2004 European Society of Cardiology
Heart failure after myocardial infarction: clinical presentation and survival
a Division of Cardiovascular Diseases and Internal Medicine Rochester, MN, USA
b Department of Health Sciences Research, Mayo Clinic and Mayo Foundation Rochester, MN, USA
* Corresponding author. Present address: Cardiovascular Epidemiology; Division of Cardiology; University Hospital Zürich; Rämistrasse 100; CH-8091 Zürich, Switzerland. Tel.: +41-1-255-1111; fax: +41-1-255-4597. E-mail address: jens.hellermann{at}usz.ch
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Abstract |
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Objectives: To characterize the presentation and outcome of patients with heart failure (HF) after myocardial infarction (MI) according to left ventricular ejection fraction (LVEF) and test the hypothesis that the outcome of HF did not change over time.
Background: Little is known about the presentation and outcome of HF post-MI and how these may have changed over time.
Methods: Using the Rochester Epidemiology Project, all residents of Olmsted County, Minnesota who experienced an incident MI between 1979 and 1998 were identified; MI and HF were validated using standardized criteria. Subjects were followed through their community medical record.
Results: Between 1979 and 1998, 1915 patients with incident MI and no prior history of HF were identified. Of these, 791(41%) experienced new onset HF as defined by Framingham criteria during 6.6±5.0 years of follow-up. Forty-seven percent were men, mean age was 73±12 years. Forty-four percent had impaired LVEF, 18% preserved LVEF and 38% had no LVEF measurement within 60 days after the HF event. Median survival after HF onset was 4 years and at 5 years after HF onset, only 45% were alive. Older age, male sex, comorbidity, hypertension and no LVEF assessment were associated with increased risk of death, however, patients with impaired LVEF had the worst outcome. Over time, survival did not improve (HR for year: 1.00; 95% CI 0.99, 1.02; P=0.919) even after adjustment for baseline characteristics.
Conclusion: In this geographically defined cohort of patients with MI, new onset HF after the MI was frequent. When measured, LVEF was most frequently reduced, consistent with systolic heart failure. Mortality was high and did not decline over time and death was independently associated with male sex, older age, hypertension and comorbidity. It also differed according to LVEF, which was inconsistently ascertained in this setting, potentially representing practice opportunities.
Key Words: Heart failure • Myocardial infarction • Population-based • Survival
Received September 16, 2003; Revised March 18, 2004; Accepted April 26, 2004
Supported in part by grants from the US Public Health Service and the National Institutes of Health (AR30582 and RO1 HL 59205) and the American Heart Association (0120646Z).
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