Abstract MP04: Contemporary Trends in Heart Failure with Reduced and Preserved Ejection Fraction after Myocardial Infarction: A Community Study
Background: Major changes have recently occurred in the epidemiology of myocardial infarction (MI), possibly affecting outcomes including heart failure (HF). Data describing trends in post-MI HF are scarce, conflicting and do not distinguish between preserved and reduced ejection fraction (EF).
Objective: To evaluate temporal trends in HF after MI.
Methods: All Olmsted County, Minnesota, residents with a first-ever MI diagnosed in 1990-2010 and no prior HF were followed-up through 2012. Framingham criteria were used to define HF, which was further classified according to EF. Secular trends in time to HF post-MI were evaluated, with year of MI categorized into 3 time periods. Early-onset (0-7 days) and late-onset (8th day-5 years) HF was examined.
Results: A total of 2,596 patients (mean (SD) age 66.5 (14.5) years, 60% men) were included. Over 5-year follow-up, 715 patients developed HF, 475 during the first week. The age- and sex-adjusted risk declined from 1990-1996 to 2004-2010, with hazard ratios (HR) of 0.67 (95% CI: 0.54-0.85) for early-onset and 0.63 (95% CI: 0.46-0.86) for late-onset HF. The competing risk-adjusted absolute risk decreased from 1990-1996 to 2004-2010 by 5.7 (95% CI: 2.5-9.0) and 5.8 (95% CI: 2.1-9.6) cases per 100 patients, for early-onset and late-onset HF, respectively. Further adjustment for comorbidities, risk factors, MI characteristics and severity indices, acute interventions and recurrent MI as a time-dependent covariate yielded HR of 0.83 (95% CI: 0.64-1.07) for early-onset and 0.62 (95% CI: 0.45-0.87) for late-onset HF. Declines in early-onset and late-onset HR were observed for HF with reduced EF (<50%), but not for HF with preserved EF (Figure).
Conclusion: Post-MI HF has declined over the last 2 decades, but this decline is confined to HF with reduced EF. Changes in MI presentation account for the reduction in early-onset HF, but do not explain the reduction in subsequent risk. Rates of HF with preserved EF did not decrease, resulting in case-mix change requiring new prevention strategies.
- © 2013 by American Heart Association, Inc.