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New-onset heart failure after acute coronary syndrome in patients without heart failure or left ventricular
Alberto Cordero1, Moisés Rodríguez-Mañero2, Vicente Bertomeu-González1
1Departamento de Cardiología, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
Insights
Nearly 10% of patients hospitalized for acute coronary syndrome develop new heart failure (HF). A simple clinical score can predict HF readmission risk, even in patients without prior HF.
Area of Science:
- Cardiology
- Heart Failure Research
- Acute Coronary Syndrome Management
Background:
- Coronary heart disease is the primary cause of heart failure (HF).
- Assessing HF risk in acute coronary syndrome (ACS) patients without prior HF is crucial.
Purpose of the Study:
- To evaluate the risk of hospital readmission for HF.
- To identify predictors of HF readmission in ACS patients without a history of HF or left ventricular dysfunction.
Main Methods:
- Prospective study involving 5962 patients across two institutions.
- Competing risk regression was used to analyze HF risk factors, with all-cause mortality as a competing event.
Main Results:
- 9.5% of patients experienced HF readmission within a median follow-up of 63 months.
- Higher HF readmission risk was linked to age, diabetes, prior coronary heart disease, high GRACE score, peripheral arterial disease, renal dysfunction, hypertension, and atrial fibrillation.
- Optimal medical treatment was associated with lower HF readmission risk.
Conclusions:
- Approximately 1 in 10 ACS patients without prior HF develop new-onset HF, with readmission risk exceeding mortality risk.
- A straightforward clinical score effectively predicts individual HF readmission risk in this population.
Introduction And Objectives:
Coronary heart disease is the leading cause of heart failure (HF). The aim of this study was to assess the risk of readmission for HF in patients with acute coronary syndrome without previous HF or left ventricular dysfunction.
Methods:
Prospective study of consecutive patients admitted for acute coronary syndrome in 2 institutions. Risk factors for HF were analyzed by competing risk regression, taking all-cause mortality as a competing event.
Results:
We included 5962 patients and 567 (9.5%) experienced at least 1 hospital readmission for acute HF. Median follow-up was 63 months and median time to HF readmission was 27.1 months. The cumulative incidence of HF was higher than mortality in the first 7 years after hospital discharge. A higher risk of HF readmission was associated with age, diabetes, previous coronary heart disease, GRACE score> 140, peripheral arterial disease, renal dysfunction, hypertension and atrial fibrillation; a lower risk was associated with optimal medical treatment. The incidence of HF in the first year of follow-up was 2.73% and no protective variables were found. A simple HF risk score predicted HF readmissions risk.
Conclusions:
One out of 10 patients discharged after an acute coronary syndrome without previous HF or left ventricular dysfunction had new-onset HF and the risk was higher than the risk of mortality. A simple clinical score can estimate individual risk of HF readmission even in patients without previous HF or left ventricular dysfunction.
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