Rates of Heart Failure After Acute MI Declining, Statewide Analysis Shows

The number of patients admitted to the hospital for heart failure following a first myocardial infarction has declined over the past 15 years, a new statewide analysis shows.  

The results, according to lead researcher Jennifer Wellings, MD (Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ), and colleagues, line up with other studies showing a significant decline in the incidence of heart failure after acute MI, a finding they attribute to prompt revascularization and better use of guideline-directed medical therapies. In the present study, for example, coronary revascularization with PCI or CABG surgery was associated with a marked decrease in hospitalization for HF.

Published online March 28, 2018, ahead of print in the American Journal of Cardiology, the study is based on an analysis of 109,717 individuals with a first acute MI included in the Myocardial Infarction Data Acquisition System (MIDAS), a database that includes all cardiovascular disease admissions to nonfederal hospitals in New Jersey.

In 2000, 3.48% of those who had an acute MI were hospitalized for HF at 1-year follow-up compared with just 1.4% of patients in 2015. Even larger reductions were observed in patients with longer follow-up. In 2000, 7.21% of acute MI patients were hospitalized for HF at 5 years follow-up compared with 1.4% of patients in 2015. The rates of admission to the hospital for HF following an acute MI in 2000 were 0.90%, 1.90%, and 2.84% at 30, 90, and 180 days, respectively. Comparatively, in 2015, the HF admission rates at the same time points were 0.67%, 1.10%, and 1.30%, respectively.

Reperfusion and Medical Therapy

Gregg Fonarow, MD (University of California, Los Angeles), who is one of the co-authors of the US guidelines for the management of HF and a member of the American Heart Association’s (AHA) Get With The Guidelines (GWTG) steering committee, said that multiple national and international studies have shown that the rates of HF after MI have declined substantially over the past 20 years. This statewide analysis is in line with those findings, he told TCTMD via email.

“The declining incidence of heart failure after acute myocardial infarction reflects the increased use of direct coronary revascularization with PCI, more rapid application of reperfusion therapy, and increasing use of evidence-based cardioprotective medications like ACE inhibitors/ARBs [angiotensin receptor blockers], beta-blockers, and high-intensity statin therapy,” he said. Greater use of guideline-directed therapy can be tied to the impact of the AHA’s GWTG and Mission: Lifeline programs, which have improved systems of care for acute MI, he added.

The researchers make a similar point in their report, noting that previous US analyses have shown a decline in the incidence of HF ranging from 10% to 40%. Similar reductions were observed in analyses from Denmark, Sweden, and Western Australia. Like Fonarow, they attribute the reduction to improved treatments for acute MI and HF, more frequent use of HF medications, and prompt reperfusion therapy. 

In the present study, older age, female sex, history of diabetes, Medicare (versus commercial insurance), history of hypertension, chronic kidney disease, and chronic obstructive pulmonary disease were all associated with a significantly increased risk of HF or mortality during follow-up. To TCTMD, Fonarow said that patients with anterior infarctions, larger infarctions, and those who delay seeking care have also been previously shown to be at a higher risk of HF.