Declining In‐Hospital Mortality and Increasing Heart Failure Incidence in Elderly Patients With First Myocardial Infarction

Abstract

Abstract.  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 7733 patients 65 years and older 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, 2831 (37%) MI patients were diagnosed with new HF and 1024 (13%) died. Among hospital survivors who did not have HF during their index hospitalization (n=4291), an additional 3040 patients (71%) developed HF by 5 years, 64% of which occurred in the first year. In total, 5871 (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<.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.—Ezekowitz JA, Kaul P, Bakal JA, et al. Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction.J Am Coll Cardiol. 2009;53(1):21–23.