Heart failure in patients admitted for acute coronary syndromes: A report from a large national registry
Raban V Jeger1, Otmar Pfister1, Dragana Radovanovic2
1Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Insights
Heart failure (HF) affects 1 in 10 acute coronary syndrome (ACS) patients, leading to high mortality, especially with acute HF. Despite ACS treatment advances, outcomes for acute HF patients remain poor.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Temporal trends of heart failure (HF) in acute coronary syndrome (ACS) are not well-documented.
- Improved ACS treatments may impact HF case-fatality rates (CFRs).
Purpose of the Study:
- To investigate the temporal trends of HF in ACS patients.
- To analyze the impact of HF on in-hospital CFRs in ACS patients.
- To assess changes in ACS and HF therapies over time.
Main Methods:
- Analysis of nationwide Acute Myocardial Infarction in Switzerland (AMIS)-Plus ACS registry data from 2000 to 2014.
- Inclusion of 36,366 ACS patients.
- Stratification based on HF presence and type (acute, chronic, decompensated).
Main Results:
- 9.3% of ACS patients had HF, with varying types: de novo acute HF (AHF), chronic HF (CHF), and acute decompensated CHF (ADCHF).
- In-hospital CFRs were highest in ADCHF (32.6%) and de novo AHF (29.7%) compared to CHF (12.9%) and no HF (3.2%).
- While CFRs decreased for non-acute HF patients, they remained high and unchanged for ADCHF and de novo AHF. ACS patients with HF received less treatment, and HF medication rates showed minimal change, with decreased beta-blocker and diuretic use in de novo AHF.
Conclusions:
- HF is a significant comorbidity in ACS, associated with substantially higher in-hospital CFRs.
- Acute HF, particularly ADCHF, carries the highest mortality risk in ACS patients.
- Despite advances in ACS care, in-hospital CFRs for acute HF in ACS have not improved over the last decade, highlighting a critical unmet need.
Background:
Data on temporal trends of heart failure (HF) in acute coronary syndrome (ACS) are scarce.
Hypothesis:
Improved treatment options may have led to lower case-fatality rates (CFRs) during the last years in ACS complicated by HF.
Methods:
Patients of the nationwide Acute Myocardial Infarction in Switzerland (AMIS)-Plus ACS registry were analyzed from 2000 to 2014.
Results:
Of 36 366 ACS patients, 3376 (9.3%) had acute or chronic HF, 2111 (5.8%) de novo acute HF (AHF), 964 (2.7%) chronic HF (CHF), and 301 (0.8%) acute decompensated CHF (ADCHF). In-hospital CFRs were highest in patients with ADCHF (32.6%) and de novo AHF (29.7%), followed by patients with CHF (12.9%) and without HF (3.2%, P < 0.001). Although in-hospital CFRs gradually decreased in CHF patients (14.3% to 4.5%, P = 0.003) and patients without HF (3.5% to 2.2%, P < 0.001), they remained high in patients with ADCHF (36.4% to 40.0%, P = 0.45) and de novo AHF (50.0% to 29.4%, P = 0.37). Although there was an increase in specific ACS therapies in the cohort over time, ACS patients with HF received significantly less pharmacological and interventional ACS therapies than patients without HF. There was no significant change in HF medication rates except less frequent use of β-blockers and diuretics in de novo AHF patients in recent years.
Conclusions:
HF is present in 1 out of 10 patients presenting with ACS and is associated with high in-hospital CFRs, particularly in acute HF. Although advances in ACS therapy improved in-hospital CFRs in patients with no HF or CHF, CFRs remained unchanged and high in patients with acute HF and ACS over the last decade.
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