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. 2023 Aug;25(8):1213-1224.
doi: 10.1002/ejhf.2965. Epub 2023 Jul 17.

Declining risk of heart failure hospitalization following first acute myocardial infarction in Scotland between 1991-2016

Kieran F Docherty  1 , Alice M Jackson  1 , Mark Macartney  2 , Ross T Campbell  1 , Mark C Petrie  1 , Marc A Pfeffer  3 , John J V McMurray  1 , Pardeep S Jhund  1
Affiliations

Declining risk of heart failure hospitalization following first acute myocardial infarction in Scotland between 1991-2016

Kieran F Docherty et al. Eur J Heart Fail. 2023 Aug.

Abstract

Aim: Mortality from acute myocardial infarction (AMI) has declined, increasing the pool of survivors at risk of later development of heart failure (HF). However, coronary reperfusion limits infarct size and secondary prevention therapies have improved. In light of these competing influences, we examined long-term trends in the risk of HF hospitalization (HFH) following a first AMI occurring in Scotland over 25 years.

Methods and results: All patients in Scotland discharged alive after a first AMI between 1991 and 2015 were followed until a first HFH or death until the end of 2016 (minimum follow-up 1 year, maximum 26 years). A total of 175 672 people with no prior history of HF were discharged alive after a first AMI during the period of study. A total of 21 445 (12.2%) patients had a first HFH during a median follow-up of 6.7 years. Incidence of HFH (per 1000 person-years) at 1 year following discharge from a first AMI decreased from 59.3 (95% confidence interval [CI] 54.2-64.7) in 1991 to 31.3 (95% CI 27.3-35.8) in 2015, with consistent trends seen for HF occurring within 5 and 10 years. Accounting for the competing risk of death, the adjusted risk of HFH at 1 year after discharge decreased by 53% (95% CI 45-60%), with similar decreases at 5 and 10 years.

Conclusion: The incidence of HFH following AMI in Scotland has decreased since 1991. These trends suggest that better treatment of AMI and secondary prevention are having an impact on the risk of HF at a population level.

Keywords: Epidemiology; Heart failure; Myocardial infarction.

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Figures

Figure 1
Figure 1
Trends in age‐standardized incidence of acute myocardial infarction 1991–2015.
Figure 2
Figure 2
Cumulative incidence of first heart failure hospitalization following first acute myocardial infarction (MI) accounting for the competing risk of death from any cause. Data are presented by year of index acute MI. Dashed lines placed at 5‐year intervals following acute MI.
Figure 3
Figure 3
Cumulative incidence of first heart failure hospitalization following first acute myocardial infarction (AMI) by type of AMI (2012–2015) accounting for the competing risk of death from any cause. NSTEMI, non‐ST‐elevation myocardial infarction; STEMI, ST‐elevation myocardial infarction.
Figure 4
Figure 4
Kaplan–Meier curves for death from any cause following a first heart failure (HF) hospitalization or time from acute myocardial infarction discharge if no HF hospitalization occurred.
See this image and copyright information in PMC

Comment in

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