This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Ezekowitz, J. A. Articles by McAlister, F. A. Search for Related Content PubMed PubMed Citation Articles by Ezekowitz, J. A. Articles by McAlister, F. A. Related Collections Related Articles

CLINICAL RESEARCH: HEART FAILURE

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

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

^_* Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
Division of General Medicine, University of Alberta, Edmonton, Alberta, Canada

Manuscript received July 3, 2008; revised manuscript received August 11, 2008, accepted August 18, 2008.

^_* Reprint requests and correspondence: Dr. Justin A. Ezekowitz, 2C2 Cardiology WMC, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada (Email: justin.ezekowitz{at}ualberta.ca).

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.

Key Words: heart failure • myocardial infarction • epidemiology

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   HF = heart failure   MI = myocardial infarction   STEMI = ST-segment elevation myocardial infarction

Related Articles

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

Azam Torabi, Alan S. Rigby, and John G.F. Cleland
J. Am. Coll. Cardiol. 2010 55: 79-81. [Full Text] [PDF]

This article has been cited by other articles:

				S. Araki, Y. Izumiya, S. Hanatani, T. Rokutanda, H. Usuku, Y. Akasaki, T. Takeo, N. Nakagata, K. Walsh, and H. Ogawa Akt1-Mediated Skeletal Muscle Growth Attenuates Cardiac Dysfunction and Remodeling After Experimental Myocardial Infarction Circ Heart Fail, January 1, 2012; 5(1): 116 - 125. [Abstract] [Full Text] [PDF]

				S. van Diepen, J. A. Bakal, F. A. McAlister, and J. A. Ezekowitz Mortality and Readmission of Patients With Heart Failure, Atrial Fibrillation, or Coronary Artery Disease Undergoing Noncardiac Surgery: An Analysis of 38 047 Patients Circulation, July 19, 2011; 124(3): 289 - 296. [Abstract] [Full Text] [PDF]

				I. Lymvaios, I. Mourouzis, D. V. Cokkinos, M. A. Dimopoulos, S. T. Toumanidis, and C. Pantos Thyroid hormone and recovery of cardiac function in patients with acute myocardial infarction: a strong association? Eur. J. Endocrinol., July 1, 2011; 165(1): 107 - 114. [Abstract] [Full Text] [PDF]

				P. Kaul, F. A. McAlister, J. A. Ezekowitz, V. K. Grover, and H. Quan Ethnic differences in 1-year mortality among patients hospitalised with heart failure Heart, July 1, 2011; 97(13): 1048 - 1053. [Abstract] [Full Text] [PDF]

				W. S. Aronow, J. L. Fleg, C. J. Pepine, N. T. Artinian, G. Bakris, A. S. Brown, K. C. Ferdinand, M. A. Forciea, W. H. Frishman, C. Jaigobin, et al. ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents Circulation, May 31, 2011; 123(21): 2434 - 2506. [Full Text] [PDF]

				W. S. Aronow, J. L. Fleg, C. J. Pepine, N. T. Artinian, G. Bakris, A. S. Brown, K. C. Ferdinand, M. Ann Forciea, W. H. Frishman, C. Jaigobin, et al. ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents Developed in Collaboration With the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension J. Am. Coll. Cardiol., May 17, 2011; 57(20): 2037 - 2114. [Full Text] [PDF]

				F. Leuschner and M. Nahrendorf Molecular Imaging of Coronary Atherosclerosis and Myocardial Infarction: Considerations for the Bench and Perspectives for the Clinic Circ. Res., March 4, 2011; 108(5): 593 - 606. [Abstract] [Full Text] [PDF]

				P. Kaul, F. A. McAlister, J. A. Ezekowitz, J. A. Bakal, L. H. Curtis, H. Quan, M. L. Knudtson, and P. W. Armstrong Resource Use in the Last 6 Months of Life Among Patients With Heart Failure in Canada Arch Intern Med, February 14, 2011; 171(3): 211 - 217. [Abstract] [Full Text] [PDF]

				M. Shafazand, A. Rosengren, G. Lappas, K. Swedberg, and M. Schaufelberger Decreasing trends in the incidence of heart failure after acute myocardial infarction from 1993-2004: a study of 175 216 patients with a first acute myocardial infarction in Sweden Eur J Heart Fail, February 1, 2011; 13(2): 135 - 141. [Abstract] [Full Text] [PDF]

				H. Shih, B. Lee, R. J. Lee, and A. J. Boyle The Aging Heart and Post-Infarction Left Ventricular Remodeling J. Am. Coll. Cardiol., January 4, 2011; 57(1): 9 - 17. [Abstract] [Full Text] [PDF]

				E. S. Chung, D. Dan, S. D. Solomon, A. J. Bank, J. Pastore, A. Iyer, R. D. Berger, J. O. Franklin, G. Jones, C. Machado, et al. Effect of Peri-Infarct Pacing Early After Myocardial Infarction: Results of the Prevention of Myocardial Enlargement and Dilatation Post Myocardial Infarction Study Circ Heart Fail, November 1, 2010; 3(6): 650 - 658. [Abstract] [Full Text] [PDF]

				M. Metra, J. G. Cleland, B. Davison Weatherley, H. C. Dittrich, M. M. Givertz, B. M. Massie, C. M. O'Connor, P. Ponikowski, J. R. Teerlink, A. A. Voors, et al. Dyspnoea in patients with acute heart failure: an analysis of its clinical course, determinants, and relationship to 60-day outcomes in the PROTECT pilot study Eur J Heart Fail, May 1, 2010; 12(5): 499 - 507. [Abstract] [Full Text] [PDF]

				G. M. Felker, P. S. Pang, K. F. Adams, J. G. F. Cleland, G. Cotter, K. Dickstein, G. S. Filippatos, G. C. Fonarow, B. H. Greenberg, A. F. Hernandez, et al. Clinical Trials of Pharmacological Therapies in Acute Heart Failure Syndromes: Lessons Learned and Directions Forward Circ Heart Fail, March 1, 2010; 3(2): 314 - 325. [Full Text] [PDF]

				A. Torabi, A. S. Rigby, and J. G.F. Cleland Declining In-Hospital Mortality and Increasing Heart Failure Incidence in Elderly Patients With First Myocardial Infarction J. Am. Coll. Cardiol., January 5, 2010; 55(1): 79 - 81. [Full Text] [PDF]

				J. A. Ezekowitz, P. Kaul, J. A. Bakal, P. W. Armstrong, R. C. Welsh, and F. A. McAlister Reply J. Am. Coll. Cardiol., January 5, 2010; 55(1): 81 - 81. [Full Text] [PDF]

				J. A. Ezekowitz What Price to Pay?: The Cost of Everything and the Value of Nothing Circulation, January 27, 2009; 119(3): 368 - 370. [Full Text] [PDF]

				C.-s. Liang and J. D. Delehanty Increasing Post-Myocardial Infarction Heart Failure Incidence in Elderly Patients: A Call for Action J. Am. Coll. Cardiol., January 6, 2009; 53(1): 21 - 23. [Full Text] [PDF]