European Heart Journal Advance Access originally published online on March 19, 2008
European Heart Journal 2008 29(7):859-870; doi:10.1093/eurheartj/ehn096
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The timing of development and subsequent clinical course of heart failure after a myocardial infarction
Department of Cardiology, Hull Royal Infirmary, University of Hull Castle Hill Hospital, Kingston-upon-Hull, Castle Road, Cottingham, East Yorkshire HU16 5JQ, UK
Received 7 July 2007; revised 31 January 2008; accepted 8 February 2008; online publish-ahead-of-print 19 March 2008.
* Corresponding author. Tel: +44 1482 624 084, Fax: +44 1482 624 085, Email: g.m.porter{at}hull.ac.uk
See page 833 for the editorial comment on this article (doi:10.1093/eurheartj/ehn067)
Aims: Myocardial infarction (MI) is a common cause of heart failure (HF), which may develop early and persist or resolve, or develop late. The cumulative incidence, persistence, and resolution of HF after MI are poorly described. The aim of this study is to describe the natural history and prognosis of HF after an MI.
Methods and results: Patients with a death or discharge diagnosis of MI in 1998 were identified from records of hospitals providing services to a local community of 600 000 people. Records were scrutinized to identify the development of HF, defined as signs and symptoms consistent with that diagnosis and treated with loop diuretics. HF was considered to have resolved if diuretics could be stopped without recurrent symptoms. Totally, 896 patients were identified of whom 54% had died by December 2005. During the index admission, 199 (22.2%) patients died, many with HF, and a further 182 (20.3%) patients developed HF that persisted until discharge, of whom 121 died subsequent to discharge. Of 74 patients with transient HF that resolved before discharge, 41 had recurrent HF and 38 died during follow-up. After discharge, 145 (33%) patients developed HF for the first time, of whom 76 died during follow-up. Overall, of 281 deaths occurring after discharge, 235 (83.6%) were amongst inpatients who first developed HF.
Conclusion: The development of HF precedes death in most patients who die in the short- or long-term following an MI. Prevention of HF, predominantly by reducing the extent of myocardial damage and recurrent MI, and subsequent management could have a substantial impact on prognosis.
Key Words: Myocardial infarction • Heart failure • Epidemiology
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