Clinical Studies
Twenty year trends (1975–1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction: A community-wide perspective

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Abstract

OBJECTIVES

To describe from a population-based perspective, recent and temporal (1975–1995) trends in the incidence, in-hospital and postdischarge case-fatality rates of heart failure (HF) complicating acute myocardial infarction (AMI).

BACKGROUND

Extremely limited data are available describing the incidence and case-fatality rates associated with HF complicating AMI from a community-wide perspective.

METHODS

The medical records of 6,798 residents of the Worcester, Massachusetts metropolitan area with validated MI and without previous HF hospitalized in 10 annual periods between 1975 and 1995 were reviewed.

RESULTS

The proportion of AMI patients developing HF during hospitalization declined between 1975–1978 (38%) and 1993–1995 (33%) (p < 0.001). After controlling for potentially confounding factors, the risk of developing HF declined progressively, albeit modestly, over time. In-hospital case-fatality rates of patients with AMI complicated by HF declined by approximately 46% between 1975–1978 (33%) and 1993–1995 (18%) (p < 0.001). Improving trends in hospital survival were observed after adjusting for potentially confounding prognostic factors. The one-year post-discharge mortality rate for hospital survivors of HF did not change over the 20-year period under study, even after controlling for additional prognostic characteristics.

CONCLUSIONS

The results of this community-wide study suggest encouraging declines in the incidence and hospital death rates associated with HF complicating AMI. Continued efforts need to be directed towards the prevention of HF given the magnitude of this clinical syndrome. Efforts of secondary prevention are needed to identify and improve the treatment of patients with symptomatic left ventricular dysfunction following AMI given the lack of improvement in the long-term prognosis of these patients.

Abbreviations

ACE
angiotensin converting enzyme
AMI
acute myocardial infarction
CABG
coronary artery bypass grafting
CFR
case-fatality rate
CI
confidence interval
HF
heart failure
MI
myocardial infarction
SMSA
standard metropolitan statistical area

Cited by (0)

This study was supported through funding provided by the National Heart, Lung, and Blood Institute (R01 HL35434).