Published Online
on October 27, 2008

A more recent version of this article appeared on November 11, 2008

This Article Full Text (PDF) CME: Take the course for this article: Circulation: November 11, 2008, Volume 118, Number 20 Data Supplement All Versions of this Article: 118/20/2057    most recent CIRCULATIONAHA.108.784215v1 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 Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Velagaleti, R. S. Articles by Vasan, R. S. Search for Related Content PubMed PubMed Citation Articles by Velagaleti, R. S. Articles by Vasan, R. S. Pubmed/NCBI databases Medline Plus Health Information Heart Attack Heart Failure Related Collections Congestive Acute myocardial infarction Epidemiology Related Article

Submitted on April 3, 2008
Accepted on August 8, 2008

Long-Term Trends in the Incidence of Heart Failure After Myocardial Infarction

Raghava S. Velagaleti MD, Michael J. Pencina PhD, Joanne M. Murabito MD, Thomas J. Wang MD, Nisha I. Parikh MD, Ralph B. D'Agostino PhD, Daniel Levy MD, William B. Kannel MD, and Ramachandran S. Vasan MD^*

From the National Heart, Lung, and Blood Institute's Framingham Heart Study (R.S. Velagaleti, M.J.P., J.M.M., T.J.W., N.I.P., R.B.D., D.L., W.B.K., R.S. Vasan), Framingham, Mass; Division of Cardiology (T.J.W.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Mathematics and Statistics (M.J.P., R.B.D.), Boston University, Boston, Mass; Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, Md (D.L.); and General Internal Medicine (J.M.M.), Preventive Medicine and Cardiology Sections (D.L., R.S. Vasan), Boston Medical Center, Boston University School of Medicine, Boston, Mass.

^* To whom correspondence should be addressed. E-mail: vasan{at}bu.edu.

Background—Although mortality after myocardial infarction (MI) has declined in the United States in recent decades, there have been few community-based investigations of the long-term trends in the incidence of heart failure after MI, and their results appear to be conflicting.

Methods and Results—We evaluated 676 Framingham Heart Study participants between 45 and 85 years of age (mean age 67 years, 34% women) who developed a first MI between 1970 and 1999. We assessed the incidence rates of heart failure and of death without heart failure in each of 3 decades (1970 to 1979, 1980 to 1989, and 1990 to 1999). We estimated the multivariable-adjusted risk of events in the latter 2 decades, with the period 1970 to 1979 serving as the referent. The 30-day incidence of heart failure after MI rose from 10% in 1970 to 1979 to 23.1% in 1990 to 1999 (P for trend 0.003), whereas 30-day mortality after MI declined from 12.2% (1970 to 1979) to 4.1% (1990 to 1999). The 5-year incidence of heart failure after MI rose from 27.6% in 1970 to 1979 to 31.9% in 1990 to 1999 (P for trend 0.02), whereas 5-year mortality after MI declined from 41.1% (1970 to 1979) to 17.3% (1990 to 1999). In multivariable analyses, compared with the period 1970 to 1979, we observed higher 30-day (risk ratio 2.05, 95% confidence interval 1.25 to 3.36) and 5-year (risk ratio 1.74, 95% confidence interval 1.07 to 2.84) risks of heart failure in the decade 1990 to 1999. These trends were accompanied by lower 30-day (risk ratio 0.21, 95% confidence interval 0.09 to 0.47) and 5-year (risk ratio 0.31, 95% confidence interval 0.18 to 0.54) mortality rates in 1990 to 1999.

Conclusions—In the present community-based sample, we observed an increase in the incidence of heart failure in recent decades that paralleled the decrease in mortality after MI.

Key words: heart failure • myocardial infarction • prognosis • risk factors • epidemiology

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