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CLINICAL STUDIES

Twenty year trends (1975–1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction

A community-wide perspective

^a Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Manuscript received January 15, 1999; revised manuscript received May 18, 1999, accepted July 19, 1999.

Reprint requests and correspondence: Dr. Robert J. Goldberg, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue, North Worcester, Massachusetts 01655

OBJECTIVES

To describe from a population-based perspective, recent and temporal (1975–1995) trends in the incidence, in-hospital and postdischarge case-fatality rates of heart failure (HF) complicating acute myocardial infarction (AMI).

BACKGROUND

Extremely limited data are available describing the incidence and case-fatality rates associated with HF complicating AMI from a community-wide perspective.

METHODS

The medical records of 6,798 residents of the Worcester, Massachusetts metropolitan area with validated MI and without previous HF hospitalized in 10 annual periods between 1975 and 1995 were reviewed.

RESULTS

The proportion of AMI patients developing HF during hospitalization declined between 1975–1978 (38%) and 1993–1995 (33%) (p < 0.001). After controlling for potentially confounding factors, the risk of developing HF declined progressively, albeit modestly, over time. In-hospital case-fatality rates of patients with AMI complicated by HF declined by approximately 46% between 1975–1978 (33%) and 1993–1995 (18%) (p < 0.001). Improving trends in hospital survival were observed after adjusting for potentially confounding prognostic factors. The one-year post-discharge mortality rate for hospital survivors of HF did not change over the 20-year period under study, even after controlling for additional prognostic characteristics.

CONCLUSIONS

The results of this community-wide study suggest encouraging declines in the incidence and hospital death rates associated with HF complicating AMI. Continued efforts need to be directed towards the prevention of HF given the magnitude of this clinical syndrome. Efforts of secondary prevention are needed to identify and improve the treatment of patients with symptomatic left ventricular dysfunction following AMI given the lack of improvement in the long-term prognosis of these patients.

Abbreviations and Acronyms   ACE = angiotensin converting enzyme   AMI = acute myocardial infarction   CABG = coronary artery bypass grafting   CFR = case-fatality rate   CI = confidence interval   HF = heart failure   MI = myocardial infarction   SMSA = standard metropolitan statistical area

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