Related Experiment Video
Updated: Feb 5, 2026
Author Spotlight: Workflow for Integrating POCUS Data into EHR for Managing Heart Failure Patients
Published on: July 12, 2024
Natural History of Patients Postacute Coronary Syndrome Based on Heart Failure Status
Andrew P Ambrosy1, Lukasz P Cerbin2, Marat Fudim1
1Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
Insights
Patients hospitalized for acute coronary syndrome (ACS) with heart failure (HF) face higher long-term risks. Pre-existing HF significantly increases mortality and hospitalization rates compared to de novo or no HF.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- The long-term prognosis for patients with acute coronary syndrome (ACS) and heart failure (HF) requires further investigation.
- Understanding the differences between pre-existing and de novo HF in ACS patients is crucial for risk stratification.
Purpose of the Study:
- To compare the natural history of patients with ACS, stratified by pre-existing HF, de novo HF, or no HF.
- To assess the long-term risks of mortality and HF hospitalizations in these patient groups.
Main Methods:
- Analysis of 14,792 patients from the IMPROVE-IT trial with recorded HF status at baseline.
- Patients were categorized into pre-existing HF, de novo HF (Killip class II+), and no HF groups.
- Long-term outcomes (death/HF hospitalizations) were analyzed over 5 years, adjusting for confounders.
Main Results:
- Patients with pre-existing or de novo HF were older, more frequently women, and had more comorbidities like atrial fibrillation and diabetes.
- At 5 years, incidences of death/HF hospitalizations were 32%/20% (pre-existing HF), 18%/7% (de novo HF), and 8%/3% (no HF).
- Both pre-existing and de novo HF independently increased the risk of death and HF hospitalizations, with pre-existing HF showing the highest risk.
Conclusions:
- Heart failure in ACS patients is associated with significantly increased long-term morbidity and mortality.
- Pre-existing HF presents a higher risk profile than de novo HF in the context of ACS.
- Lipid-lowering therapy did not interact with baseline HF status to affect clinical outcomes.
Abstract:
The natural history of patients hospitalized for acute coronary syndrome (ACS) with pre-existing versus (vs) de novo heart failure (HF) has not been previously reported over an extended duration of follow-up. The IMPROVE-IT trial enrolled 18,144 patients hospitalized for ACS and randomized them to combination simvastatin (40 mg)/ezetimibe (10 mg) vs simvastatin (40 mg). Subjects were divided into 3 groups: pre-existing HF (i.e., defined by past medical history), de novo HF (i.e., defined by Killip class II or greater during index admission), and no HF. The final analytical cohort included 14,792 patients (82%) with HF status recorded at baseline. In total, 790 patients (5.3%) reported a pre-existing diagnosis of HF and 1374 patients (9.3%) experienced de novo HF. Patients with pre-existing or de novo HF were older, more likely to be woman, and had a greater prevalence of atrial fibrillation and diabetes mellitus. The incidences of death/HF-hospitalizations at 5 years were 32%/20% for pre-existing HF, 18%/7% for de novo HF, and 8%/3% for no HF. After adjusting for potential confounders, a history of pre-existing or de novo HF was independently associated with increased risk of death (pre-existing HF: hazard ratio [HR] 1.93, 95% confidence interval [CI] 1.68 to 2.22, p < 0.001; de novo HF: HR 1.51, 95% CI 1.33 to 1.72, p < 0.001) and hospitalizations for HF (pre-existing HF: HR 2.96, 95% CI 2.36 to 3.71, p < 0.001; de novo HF: HR 1.88, 95% CI 1.49 to 2.38, p < 0.001). There was no interaction among baseline HF status (i.e., pre-existing or de novo), lipid lowering therapy (i.e., simvastatin/ezetimibe vs simvastatin alone), and clinical outcomes. In conclusion, patients hospitalized for ACS with pre-existing or de novo HF were older and had a greater burden of medical co-morbidities. In conclusion, HF was independently associated with increased risk of long-term morbidity and mortality with the pre-existing HF cohort demonstrating the highest overall risk.
More Related Videos
14:35Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:29Heart Failure II: Pathophysiology
01:17Pathophysiology of Heart Failure
01:27Heart Failure I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:22Heart Failure VI: Adjunct Therapies