Within Four Years of First MI, One Patient in Four Develops Heart Failure, Database Suggests

Nearly one in four patients who have had an MI will go on to develop heart failure (HF) in the intervening four years, contemporary data suggest.

“We found a relatively high incidence of heart failure after myocardial infarction in the current study despite the uptake of primary PCI in the UK,” said study author Johannes Gho, MD, PhD (University Medical Center Utrecht, the Netherlands), in an email to TCTMD. He added that earlier studies, predominantly from the thrombolytic era, also showed similarly high rates of post-MI HF. 

Gho’s study, which was presented at Heart Failure 2016 and the 3^rd World Congress on Acute Heart Failure this week in Florence, Italy, used linked electronic health records from the UK-based CALIBER database, which links primary care data to hospital admissions and national MI and mortality registries. Gho and colleagues then examined timing and risk factors for HF in 24,745 patients in the database who experienced a first MI between 1998 and 2010.

Age, Economics, Comorbidities Implicated

At a median of 3.7 years, 24.3% of patients developed HF. Among the factors found to be predictive were older age and greater socioeconomic deprivation. For every 10-year increase in age, for example, a 45% increase in risk was seen. Likewise, patients in the fifth vs the first quintile of socioeconomic deprivation demonstrated an increased risk of about 27%.

HF developed within the first 30 days in about 10.0% of patients. Among those who were event-free in the first 30 days, 13.1% subsequently developed HF over the following 5 years. Similarly, a comparison of 3-year follow up for patients with an index MI between 1998-2001 vs 2004-2007 showed similar rates of post-MI HF.

Independent baseline clinical predictors of HF included diabetes (44% increased risk), A-Fib (63% increased risk), PAD (38% increased risk), COPD (28% increased risk), hypertension (16% increased risk), and STEMI at presentation (21% increased risk).

Gho said it is important to note that some of these risks are modifiable, and said clinicians should focus efforts toward identifying and intervening as early as possible in patients after a first MI.

“We think that hypertension and diabetes are important risk factors for which improved guideline recommended treatment is possible,” he said.

To TCTMD, his co-author, Folkert Asselbergs, MD, PhD (also University Medical Center Utrecht), concurred about the importance of regulating blood pressure and optimizing diabetes treatment in these patients, adding that closer monitoring is needed for this vulnerable patient population at risk for incident heart failure.

Source:
Gho J. Heart failure following myocardial infarction: a cohort study of incidence and prognostic factors in 24,745 patients using linked electronic records. Presented at: Heart Failure 2016 and the 3^rd World Congress on Acute Heart Failure; May 24, 2016; Florence, Italy.

Disclosures:

• Gho and Asselbergs report no relevant conflicts of interest.

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