Influence of heart failure symptoms and ejection fraction on short- and long-term outcomes for older patients with non–ST-segment elevation myocardial infarction - 20/01/14
, Anita Y. Chen, MSc b, Tracy Y. Wang, MD, MHS, MSc b, Karen P. Alexander, MD b, Justin A. Ezekowitz, MBBCh, MSc c, Eric D. Peterson, MD, MPH b, Matthew T. Roe, MD, MHS bRésumé |
Background |
Symptomatic heart failure (HF) and reduced ejection fraction (REF) are both associated with mortality, but the long-term outcomes associated with the development of HF in older non–ST-segment elevation myocardial infarction (NSTEMI) patients with preserved systolic function and REF are uncertain.
Methods |
We analyzed a total of 26,291 NSTEMI patients ≥65 years discharged alive in the CRUSADE Registry who had linked Medicare data. We evaluated 30-day and 1-year risks of mortality and HF readmission in 4 cohorts of patients stratified by symptomatic HF and ejection fraction: (1) no HF-PEF, (2) no HF-REF, (3) HF-PEF, and (4) HF-REF.
Results |
A total of 14,280 NSTEMI patients (54.3%) had no HF-PEF, 3,345 (12.7%) had no HF-REF, 4,913 (18.7%) had HF-PEF, and 3,753 (14.3%) had HF-REF. Compared with no HF-PEF patients, the 30-day mortality risk was higher among patients with no HF-REF (4.9% vs 1.7%, adjusted hazard ratio 2.11, 95% CI 1.69-2.63), HF-PEF (5.9% vs 1.7%, adjusted hazard ratio 1.99, 95% CI 1.64-2.41), and highest among those with HF-REF (9.3% vs 1.7%, adjusted hazard ratio 2.70, 95% CI 2.23-3.26). Similar relationships were noted in the adjusted 1-year mortality and the risks of 30-day and 1-year HF readmission.
Conclusions |
Symptomatic HF and REF during the index NSTEMI hospitalization are both associated with an increased risk of short- and long-term mortality as well as HF readmission with an apparent additive prognostic impact of both factors.
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Vol 167 - N° 2
P. 267 - février 2014 Retour au numéro
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