Abstract MP85: Prognostic Impact of Heart Failure with Preserved and Reduced Ejection Fraction after Myocardial Infarction in the Community
Background: Contemporary community data on the prognostic importance of heart failure (HF) after myocardial infarction (MI) according to (1) preserved or reduced ejection fraction (EF) and (2) the time of its occurrence are lacking. We examined HF-associated mortality and secular trends in survival among patients with and without HF in a geographically defined cohort of MI survivors.
Methods: All residents of Olmsted County, Minnesota (n=2,596) who had a first MI diagnosed in 1990-2010 and no prior HF were followed through 2012 for HF incidence and mortality. Framingham Heart Study criteria were used to define HF, which was further classified according to EF. Cox models were used to examine (1) the hazard ratios (HRs) for death associated with HF type (preserved or reduced) and timing (early- or late-onset); and (2) secular trends in survival by HF status.
Results: During a mean (SD) follow-up of 4 (3) years, 748 patients developed HF (519 within 30 days) and 673 died. After adjusting for age, sex, and year of index MI, HF as a time-dependent variable was strongly associated with mortality (HR=3.33 vs. HF-free subjects). Mortality did not differ by HF type, but was markedly higher for late-onset (>30 days) than for early-onset HF. Further adjustment for indicators of MI severity and comorbidity burden, acute intervention, and recurrent MI attenuated the association (Table). The age- and sex-adjusted HRs for mortality in 2001-2010 vs. 1990-2000 were 0.71 (95% CI: 0.58-0.88) in HF and 0.74 (95% CI: 0.59-0.93) in HF-free patients. These estimates equate to 10.18 (95% CI: 3.82-16.54) and 3.75 (95% CI: 0.90-6.61) fewer deaths per 100 subjects at 5 years of follow-up in participants with and without HF, respectively.
Conclusions: HF markedly increases the risk of death after MI. The magnitude of this excess risk is similar between preserved and reduced EF but greater for late- vs. early-onset HF. Mortality declined over time in all patients with MI, and the absolute reduction in the risk of death was substantially greater for those with HF.
Author Disclosures: Y. Gerber: None. S.A. Weston: None. C. Berardi: None. A.M. Chamberlain: None. S.M. McNallan: None. R. Jiang: None. S.M. Dunlay: None. V.L. Roger: None.
- © 2014 by American Heart Association, Inc.