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Do patients with heart failure appropriately undergo invasive procedures post-myocardial infarction? Results from a
D Tobing1, J French, J Varigos
1Liverpool Hospital and South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
Insights
Patients with congestive heart failure (CHF) after myocardial infarction (MI) received fewer guideline-recommended angiography and angioplasty procedures. Future strategies are needed to improve the use of these life-saving interventions for CHF patients post-MI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Management
Background:
- Adherence to early angiography and angioplasty guidelines for myocardial infarction (MI) patients with co-existing congestive heart failure (CHF) is not well-understood.
- Investigating procedural rates in this specific patient cohort is crucial for optimizing cardiac care.
Purpose of the Study:
- To prospectively evaluate the utilization of invasive cardiac procedures in patients who experienced myocardial infarction (MI) and had concurrent congestive heart failure (CHF).
- To compare the rates of angiography and angioplasty between MI patients with and without CHF.
Main Methods:
- Prospective evaluation of invasive procedures in 475 post-MI patients across 16 Australian hospitals over one month.
- Patients were stratified by the presence of congestive heart failure (CHF) and type of myocardial infarction (STEMI/non-STEMI).
- Statistical analysis was performed to compare procedure rates, adjusting for clinical covariates and age.
Main Results:
- 112 (23.6%) of post-MI patients had CHF; these patients were older and more frequently women compared to those without CHF.
- Patients with CHF underwent significantly fewer angiography (72.3% vs. 85.1%) and angioplasty (33.9% vs. 52.9%) procedures compared to non-CHF patients.
- These disparities persisted even after adjusting for clinical factors and were also observed in STEMI patients and the elderly population.
Conclusions:
- Congestive heart failure (CHF) significantly reduces the likelihood of receiving guideline-recommended angiography and angioplasty after myocardial infarction (MI).
- This underutilization is not attributable to lower rates in the elderly population.
- Enhanced strategies are necessary to increase the uptake of these potentially life-saving procedures in post-MI patients with CHF.
Background:
The degree of adherence to guideline recommendations that patients following myocardial infarction (MI) with congestive heart failure (CHF) undergo early angiography, and angioplasty if indicated, is unknown.
Methods:
We prospectively evaluated the use of invasive procedures in patients with segment-elevation myocardial infarction (STEMI), non-STEMI and CHF, admitted in 1 month to 16 Australian hospitals.
Results:
Of 475 post-MI patients (248 (52.2%) with STEMI), 112 (23.6%) had CHF, (57 (23.0%) with STEMI). Patients with CHF, compared with those without CHF, were older (67.8 vs 63.2 years; P = 0.002) and were more often women (34 vs 24%, P = 0.03), but had similar rates of other risk factors. Compared with post-MI patients without CHF, patients with CHF had fewer invasive procedures: angiography 72.3% versus 85.1% (P = 0.002) and angioplasty 33.9% versus 52.9% (P < 0.001) (12 (2.5%) patients underwent coronary surgery in-hospital); and among STEMI patients (angiography 72.3% CHF vs 89.5% no CHF [P < 0.001]; angioplasty 50.9% CHF vs 69.1% no CHF [P = 0.011]); these differences remained significant after adjustment for clinical covariates. Of the 121 (25.5%) post-MI patients aged > or =75 years, compared with those <75 years, the frequencies of angiography and angioplasty procedures were 66.1% versus 87.6% (P < 0.001) and 33.9% versus 53.4% (P < 0.001), respectively; 66% of the elderly with, and without, CHF had angiography.
Conclusion:
The presence of CHF post-MI resulted in lower rates of use of angiography and angioplasty, which was not explained by lower procedure rates in the elderly. As these guideline-recommended procedures may improve survival in patients with CHF post-MI, future strategies should aim to enhance their use.
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