title: Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction.
abstract: OBJECTIVE
  The purpose of this study was to examine the long-term incidence of heart failure (HF) in elderly patients with myocardial infarction (MI).
  
  
  BACKGROUND
  In-hospital HF is common after MI and is associated with poor short-term prognosis. Limited data exist concerning the long-term incidence or prognosis of HF after MI, particularly in the era of coronary revascularization.
  
  
  METHODS
  A population-based cohort of 7,733 patients > or = 65 years of age hospitalized for a first MI (International Classification of Diseases-9th Revision-Clinical Modification code 410.x) and without a prior history of HF was established between 1994 and 2000 in Alberta, Canada, and followed up for 5 years.
  
  
  RESULTS
  During the index MI hospitalization, 2,831 (37%) MI patients were diagnosed with new HF and 1,024 (13%) died. Among hospital survivors who did not have HF during their index hospitalization (n = 4,291), an additional 3,040 patients (71%) developed HF by 5 years, 64% of which occurred in the first year. In total, 5,871 (76%) elderly patients who survived their first MI developed HF over 5 years. Among those who survived the index hospitalization, the 5-year mortality rate was 39.1% for those with HF during the index MI hospitalization compared with 26.7% among those without HF (p < 0.0001) during the index MI hospitalization. Over the study period, the 5-year mortality rate after MI decreased by 28%, whereas the 5-year rate of HF increased by 25%.
  
  
  CONCLUSIONS
  In this large cohort of elderly patients without a history of HF, HF developed in three-quarters in the 5 years after their first MI; this proportion increased over time as peri-MI mortality rates declined. New-onset HF significantly increases the mortality risk among these patients.
authors.affiliation: Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada. justin.ezekowitz@ualberta.ca
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.forename: Padma
authors.initials: P
authors.lastname: Kaul
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Bakal
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Robert C
authors.initials: RC
authors.lastname: Welsh
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors