Abstract 3141: Heart Failure Predictors and Outcomes after Acute Myocardial Infarction in the Elderly
Heart failure (HF) is common after acute myocardial infarction (AMI) and is associated with poor short-term prognosis. However, little long term data exist concerning the incidence or prognosis of HF in the elderly after AMI. Our objectives were to examine:
the 5-year incidence of HF and its impact on mortality among elderly (age±65 years) AMI patients; and
baseline predictors of new onset HF and mortality post-AMI. Of 13460 elderly patients hospitalized in Alberta with AMI (ICD-9 code 410.x) between 04/01/1993 and 03/31/2000; those with prior HF (n=2909, 22%) or prior MI (n=2011, 15%) were excluded resulting in a final study population of 8992 patients.
New onset HF during the index hospitalization or in a subsequent physician visit or hospitalization was identified. A multi-state model (extension of the Cox proportional hazards model) was developed to identify baseline factors independently associated with the development of HF, as well as mortality in patients who did and did not develop HF. During the index hospitalization, 3207 (24%) patients were diagnosed with HF and 1250 (9%) died. In patients who survived the index hospitalization, the five-year mortality rate was 39.1% for those with HF during AMI compared with 26.7% among those without HF (p < 0.0001) during the index AMI. Among hospital survivors who were not diagnosed with HF during the index hospitalization (n=5067), an additional 2859 patients (56%) developed HF by 5 years. The risk factors for developing HF and for mortality in patients who did and did not develop HF are listed in the Table⇓. In a cohort of elderly AMI patients with no history of HF, almost three quarters had developed HF by 5 years. New-onset HF not only significantly increases the mortality risk among these patients; it also augments the mortality hazard associated with other risk factors.