Abstract 17546: No Decrease in the Incidence of Heart Failure Following Acute Myocardial Infarction in the Years 1994-2006

Abstract

Objectives: Heart failure (HF) is a common serious complication following acute myocardial infarction (MI). We studied whether improvements in MI treatment had an impact on the incidence of post-MI HF. Methods: We used data from the Myocardial Infarction Data Acquisition System (MIDAS) database, selecting all first myocardial infarctions admitted to non-federal hospitals in the state of New Jersey between 1994 and 2006. We studied the incidence of HF during admission, within 28 days of admission, and 28 days to one year from admission. Using a multivariate model, we assessed which clinical characteristics had an impact on the incidence of HF. Results: A total of 185,483 patients were admitted with a first MI. The incidence of HF within one year was 38.2% in 1994 and remained stable through 2006 (range 37.6% - 41.0%). The incidence of HF in patients with subendocardial MI was also stable and significantly higher than that observed in transmural MI (43.7% vs. 30.9%, p<0.0001). However, among patients with transmural MI, HF incidence within one year declined from 32.8% in 1994 to 26.3% in 2006 (p<0.0001), mainly due to a decline in HF during the index admission. HF incidence after discharge remained stable in transmural MI and increased in subendocardial MI. By multivariate modeling, older age, female gender, black race, diabetes, atrial fibrillation, renal disease, and chronic obstructive pulmonary disease were associated with higher incidence of HF (p<0.0001 for all). Patient age and the rates of diabetes, hypertension, renal disease, cancer, and anemia increased during the period of observation (p<0.0001). Conclusions: Despite major advances in management of acute myocardial MI, the incidence of post-MI HF remained stable. The only decline observed was in HF during an index admission for transmural MI. Subendocardial MI was associated with a higher HF incidence. These findings may be due to the increasing age and rates of comborbidities among patients with first MI.