Author + information
- Received August 26, 2014
- Revision received September 26, 2014
- Accepted October 3, 2014
- Published online March 1, 2015.
- Liyew Desta, MD∗∗ (, )
- Tomas Jernberg, MD, PhD†,
- Ida Löfman, MD†,
- Claes Hofman-Bang, MD, PhD∗,
- Inger Hagerman, MD, PhD†,
- Jonas Spaak, MD, PhD∗ and
- Hans Persson, MD, PhD∗
- ∗Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
- †Department of Cardiology, Karolinska University Hospital, Huddinge, Stockholm
- ↵∗Reprint requests and correspondence:
Dr. Liyew Desta, Department of Clinical Sciences, Section of Cardiology, Danderyd University Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden.
Objectives The aim of this study was to examine temporal trends in the incidence and outcomes of heart failure (HF) complicating acute myocardial infarction (AMI) in a large national cohort.
Background There are limited and conflicting data concerning temporal trends in the incidence and prognostic implication of in-hospital HF that complicates AMI.
Methods The nationwide coronary care unit registry SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) records baseline characteristics, treatments, and outcome of consecutive patients with AMIs admitted to all hospitals in Sweden. The diagnosis of HF requires the presence of crackles (Killip class ≥II) or the use of intravenous diuretic agents or intravenous inotropes. This study included 199,851 patients admitted for index AMIs between 1996 and 2008.
Results The incidence of HF declined from 46% to 28% (p < 0.001). This decrease was more pronounced in patients with ST-segment elevation myocardial infarctions and left bundle branch block (from 50% to 28%) compared with those with non-ST-segment elevation myocardial infarctions (from 42% to 28%) (p < 0.001). The in-hospital, 30-day, and 1-year mortality rates for patients who developed HF during the index myocardial infarction decreased over the years from 19% to 13%, from 23% to 17%, and from 36% to 31%, respectively (p < 0.001 for all). Thirteen-year survival analysis showed higher mortality in patients with HF compared with those without HF (adjusted hazard ratio: 2.1; 95% confidence interval: 2.06 to 2.13).
Conclusions A marked decrease was found in the incidence of HF complicating AMI between 1996 and 2008. However, HF continues to worsen the early-, intermediate-, and long-term adverse prognostic risk after AMI.
Drs. Desta and Persson have received grant funding from the board of the Swedish Heart Failure Registry and the Swedish Heart and Lung Foundation, respectively. None of the sponsors participated in the design or conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 26, 2014.
- Revision received September 26, 2014.
- Accepted October 3, 2014.
- American College of Cardiology Foundation