Abstract 16428: Incidence and Survival Trends of Heart Failure Complicating First Myocardial Infarction in Western Australia between 1996 and 2007
Background: Heart failure (HF) complicating acute myocardial infarction (AMI) is associated with an adverse prognosis. We examined incidence and survival trends of HF complicating first (index) AMI in Western Australia (WA) between 1996 and 2007.
Methods: The WA Hospital Morbidity Database was used to identify patients hospitalized with an index AMI between 1996 and 2007 without a prior history of HF. We determined the incidence of HF which occurred early (within 28 days) and late (>28-day) after AMI onset. Risk-adjusted multivariate regression models provided odds ratios (OR) for death at 1-year using 1996–1998 as the baseline period.
Results: Among 23,489 index AMI patients (mean age 67 years, 32.3% women), 29.7% developed HF post-MI (19.9% early-onset, 9.9% late-onset). Patients who developed HF were older, more likely female, and had a higher prevalence of diabetes, atrial fibrillation, hypertension, renal disease and peripheral vascular disease compared to those without HF (all p<0.001). Over the period, age-standardized rate of HF increased from 81 to 88 per 100,000 in men but declined from 53 to 47 per100,000 in women. From 1996 to 2007, the proportion of early-onset HF declined from 26% to 16% whilst late-onset HF increased from 5% to 13%. HF complicating AMI (vs no HF) was associated with a 1-year adjusted mortality OR of 1.52 (95% CI 1.39–1.67). The risk-adjusted mortality of patients complicated by HF declined from 1996 to 2007, with a 1-year mortality OR of 0.59 (95% CI 0.49–0.71) for those admitted in 2005–2006 compared to baseline. In patients who developed HF, any coronary artery revascularization procedure was associated with a reduced OR of death at 1-year (OR 0.33; 95% CI 0.28–0.38).
Conclusions: Between 1996 and 2007, the age-standardized incidence of new HF complicating index AMI showed opposite trends in men and women, and a decline in early-onset HF was offset by increase in late-onset HF. Although HF complicating AMI was associated with an adverse prognosis, there has been a substantial decline in risk-adjusted 1-year mortality over the period, which may be partly due to an increased uptake of coronary artery revascularisation procedures.
- © 2010 by American Heart Association, Inc.