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European Heart Journal Advance Access published online on November 11, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn503
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Impact of hospitalization for acute coronary events on subsequent mortality in patients with chronic heart failure

Putte Abrahamsson1,*, Joanna Dobson2, Christopher B. Granger3, John J.V. McMurray4, Eric L. Michelson5, Marc Pfeffer6, Stuart Pocock2, Scott D. Solomon6, Salim Yusuf7, Karl Swedberg1 for the CHARM Investigators

1 Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2 Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
3 Department of Cardiology, Duke University Medical Center, Durham, NC, USA
4 British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
5 AstraZeneca LP, Wilmington, DE, USA
6 Department of Cardiology, Brigham and Women's Hospital and Harvard University, Boston, MA, USA
7 Department of Medicine, HGM-McMaster Clinic, Hamilton, Ontario, Canada

Received 25 June 2008; revised 8 October 2008; accepted 20 October 2008.

* Corresponding author: Department of Medicine, Sahlgrenska University Hospital/Östra, S-416 85 Göteborg, Sweden. Tel: +46313435575, Fax: +4631258933, Email: putte.abrahamsson{at}vgregion.se

Aims: We explored the impact of having a hospital admission for an acute coronary syndrome (ACS) on the subsequent prognosis among patients with chronic heart failure (CHF).

Methods and results: A total of 7599 patients with CHF, New York Heart Association Classes II–IV, were randomly assigned to candesartan or placebo. We assessed the risk of death after a first ACS using time-updated Cox proportional hazard models adjusted for baseline predictors. During a mean follow-up of 3.3 years, 1174 patients experienced at least one ACS. Myocardial infarction (MI) was the first ACS in 442 subjects and unstable angina (UA) in 732. After these events, 219 (49.5%) and 167 (22.8%) patients died during follow-up. The early risk of death was more pronounced after MI: 30.2% died within 30 days compared with 3.6% after UA. After an ACS event, the risk of death declined steadily over time, although 18 months after an MI the risk was still twice that of patients without an ACS.

Conclusion: Patients with CHF, who develop an ACS, have markedly increased subsequent mortality, particularly in the early phase after an MI.

Key Words: Chronic heart failure • Acute myocardial infarction • Unstable angina pectoris • Prognosis


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