Temporal Trends in Post Myocardial Infarction Heart Failure and Outcomes among Older Adults.

Abstract

OBJECTIVES\nTo determine national trends and long term outcomes of post myocardial infarction (MI) heart failure.\n\n\nBACKGROUND\nMyocardial infarction (MI) can be complicated by heart failure; there are limited data describing the contemporary patterns and clinical implications of post-MI heart failure.\n\n\nMETHODS\nWe studied MI patients aged ≥ 65 years from 2000-2013 in a Medicare database. New onset heart failure post-MI was defined as either heart failure during index MI admission or a hospitalization for heart failure within 1 year of index MI event. A trend analysis of the incidence of heart failure was performed, differences were examined by Gray tests. The 5-year mortality rates were evaluated and differences among heart failure cohorts were ascertained by Gray tests.\n\n\nRESULTS\nThere were a total of 1,531,638 MI patients and 565,291 patients had heart failure (36.0%). The rate of heart failure during index admission was 32.3% and the frequency of heart failure hospitalization within 1 year was 10.4%. Patients with heart failure were older (81 vs 77 years). The temporal trend from 2001-2012 suggested a reduction in the incidence of heart failure during index admission (2001: 34.7%, 2012: 31.2%, p-trend < 0.01), as well as heart failure hospitalization within 1 year (2001: 11.3%, 2012: 8.7%, p-trend < 0.01). The 5-year mortality rate among patients without heart failure was 38.4% and for patients with any heart failure it was 68.7%.\n\n\nCONCLUSION\nPost-MI heart failure in older adults occurs in 1 in 3 patients within 1 year; heart failure portends significantly higher long-term mortality.