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Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial
Justin A Ezekowitz1, Padma Kaul, Jeffery A Bakal
1Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada. justin.ezekowitz@ualberta.ca
Insights
Heart failure (HF) developed in 76% of elderly patients within 5 years of their first myocardial infarction (MI). This incidence rose as mortality rates declined, highlighting HF as a significant risk factor for elderly MI survivors.
Area of Science:
- Cardiology
- Geriatric Medicine
- Public Health
Background:
- In-hospital heart failure (HF) post-myocardial infarction (MI) is common and linked to poor short-term outcomes.
- Limited data exist on the long-term incidence and prognosis of HF following MI, especially with modern treatments.
Purpose of the Study:
- To investigate the long-term incidence of heart failure (HF) in elderly patients after a first myocardial infarction (MI).
Main Methods:
- A population-based cohort of 7,733 elderly patients (≥65 years) hospitalized for a first MI without prior HF was established.
- Patients were followed for 5 years to track the development of HF and mortality rates.
Main Results:
- During initial hospitalization, 37% of MI patients developed new HF; 13% died.
- Among hospital survivors without HF, 71% developed HF within 5 years, with most cases occurring in the first year.
- Overall, 76% of elderly MI survivors developed HF within 5 years, and new-onset HF significantly increased 5-year mortality risk.
Conclusions:
- HF develops in a substantial majority of elderly patients within 5 years of their first MI.
- The increasing incidence of HF post-MI correlates with declining mortality rates, indicating a shift in post-MI complications.
- New-onset HF is a critical factor escalating mortality risk in elderly patients surviving their first MI.
Objectives:
The purpose of this study was to examine the long-term incidence of heart failure (HF) in elderly patients with myocardial infarction (MI).
Background:
In-hospital HF is common after MI and is associated with poor short-term prognosis. Limited data exist concerning the long-term incidence or prognosis of HF after MI, particularly in the era of coronary revascularization.
Methods:
A population-based cohort of 7,733 patients > or = 65 years of age hospitalized for a first MI (International Classification of Diseases-9th Revision-Clinical Modification code 410.x) and without a prior history of HF was established between 1994 and 2000 in Alberta, Canada, and followed up for 5 years.
Results:
During the index MI hospitalization, 2,831 (37%) MI patients were diagnosed with new HF and 1,024 (13%) died. Among hospital survivors who did not have HF during their index hospitalization (n = 4,291), an additional 3,040 patients (71%) developed HF by 5 years, 64% of which occurred in the first year. In total, 5,871 (76%) elderly patients who survived their first MI developed HF over 5 years. Among those who survived the index hospitalization, the 5-year mortality rate was 39.1% for those with HF during the index MI hospitalization compared with 26.7% among those without HF (p < 0.0001) during the index MI hospitalization. Over the study period, the 5-year mortality rate after MI decreased by 28%, whereas the 5-year rate of HF increased by 25%.
Conclusions:
In this large cohort of elderly patients without a history of HF, HF developed in three-quarters in the 5 years after their first MI; this proportion increased over time as peri-MI mortality rates declined. New-onset HF significantly increases the mortality risk among these patients.
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