title: Long term prognosis of heart failure after acute coronary syndromes without ST elevation.
abstract: BACKGROUND
  Information about long term outcomes of patients with acute coronary syndromes (ACS) who have clinically diagnosed heart failure is scarce.
  
  
  METHODS
  In a UK registry, this study evaluated patients with non-ST elevation ACS, recording treatment, and clinical outcomes for six months. In a subgroup, a four year mortality follow up was performed to estimate the impact of the clinical diagnosis of heart failure on survival.
  
  
  RESULTS
  Of 1046 patients, 139 (13%) had a history of clinically diagnosed heart failure. At discharge, ACE inhibitors were prescribed for 58% and 28%, of those with and without a history of heart failure respectively (p<0.001). Rates of angiography, percutaneous intervention, and coronary artery bypass graft were 17.3% and 29.2% (p = 0.003), 5.0% and 8.4% (p = 0.17), and 5.0% and 7.5% (p = 0.3) for these groups respectively. Death or new myocardial infarction at six months occurred in 22% and 10% (p<0.001) and at four years death occurred in 60% and 20% of these groups respectively (p<0.001). In a multivariate analysis prior heart failure carried an odds ratio of 2.0 (p = 0.001) for death or myocardial infarction at six months and 2.4 (p<0.001) for death over four years. New heart failure was associated with an increased risk of death at six months (20% compared with 5%, p<0.001).
  
  
  CONCLUSIONS
  A clinical history of heart failure carries a substantial risk of death in patients admitted with ACS without ST elevation. Nearly 60% of those with prior heart failure are dead after four years. After adjustment for confounding factors, prior heart failure more than doubles the risk compared with those with no history.
authors.affiliation: Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London, UK.
authors.forename: M C
authors.initials: MC
authors.lastname: Shibata
authors.forename: J
authors.initials: J
authors.lastname: Collinson
authors.forename: A K
authors.initials: AK
authors.lastname: Taneja
authors.forename: A
authors.initials: A
authors.lastname: Bakhai
authors.forename: M D
authors.initials: MD
authors.lastname: Flather
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology