title: Predictors of the first heart failure hospitalization in patients who are stable survivors of myocardial infarction complicated by pulmonary congestion and/or left ventricular dysfunction: a VALIANT study.
abstract: OBJECTIVE
  We sought to assess the incidence of and prognostic factors for heart failure (HF) hospitalization among survivors of high-risk acute myocardial infarction (MI).
  
  
  RESULTS
  We assessed the risk of an initial hospitalization for HF in 11 040 stable MI patients (no major non-fatal cardiovascular events or deaths within 45 days of randomization) without a prior history of HF enrolled in the VALIANT trial. Multivariable models were developed to identify independent predictors of HF and HF or cardiovascular death. Of 11 040 stable post-MI patients, 1139 (10.3%) developed HF during the median 25-month follow-up at a rate of approximately 3.4% per year. Most patients, 824 (72.3%), did not have a symptomatic recurrent MI between randomization and the onset of HF. The most important predictors of HF were older age, antecedent diabetes, prior MI before index MI, and reduced renal function. HF markedly increased the risk of death [HR(hazard ratio) 8.22; 95% CI(confidence interval), 7.49-9.01].
  
  
  CONCLUSIONS
  HF post high risk-MI occurs in a time-dependent fashion and is usually not directly related to re-infarction. Patients who experience HF beyond the acute phase have increased mortality. Long-term survivors of high-risk MI should be followed closely and treated aggressively beyond the acute MI period.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. eflewis@partners.org
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Anne S
authors.initials: AS
authors.lastname: Hellkamp
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Jasmine
authors.initials: J
authors.lastname: Mathias
authors.forename: Jean-Lucien
authors.initials: JL
authors.lastname: Rouleau
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Lars
authors.initials: L
authors.lastname: Kober
authors.forename: Harvey
authors.initials: H
authors.lastname: White
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Dalby
authors.forename: Gary S
authors.initials: GS
authors.lastname: Francis
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D011654:Pulmonary Edema / Q000150:complications / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality*