Author + information
- Received July 3, 2008
- Revision received August 11, 2008
- Accepted August 18, 2008
- Published online January 6, 2009.
- Justin A. Ezekowitz, MBBCh, MSc⁎,⁎ (, )
- Padma Kaul, PhD⁎,
- Jeffery A. Bakal, PhD†,
- Paul W. Armstrong, MD⁎,†,
- Robert C. Welsh, MD⁎ and
- Finlay A. McAlister, MD, MSc‡
- ↵⁎Reprint requests and correspondence:
Dr. Justin A. Ezekowitz, 2C2 Cardiology WMC, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada
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 ≥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.
Dr. Ezekowitz is supported by the Randomized Controlled Trials program of the Canadian Institutes of Health Research (CIHR). Dr. Kaul is supported by the CIHR and Alberta Heritage Foundation for Medical Research (AHFMR). Dr. McAlister is supported by the CIHR, the AHFMR, and the Merck Frosst-Aventis Chair in Patient Health Management. This study is supported by an Operating Grant from the CIHR. Although the study is based in part on data provided by Alberta Health and Wellness, the interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Alberta. The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Neither the Government nor Alberta Health and Wellness express any opinion in relation to this study. The study was reviewed and approved by the ethics board of the University of Alberta.
- Received July 3, 2008.
- Revision received August 11, 2008.
- Accepted August 18, 2008.
- American College of Cardiology Foundation