Unrecognised myocardial infarction and long-term risk of heart failure in the elderly: the Rotterdam Study.
OBJECTIVE
To examine the association between unrecognised myocardial infarction (MI) as detected by electrocardiography and the long-term risk of heart failure.


METHODS
The Rotterdam Study is a prospective population-based cohort study of the general population of a suburb of the city of Rotterdam, The Netherlands.


METHODS
At baseline 2581 men and 3724 women aged > or =55 years were classified on the basis of electrocardiography, interview and clinical data into those with recognised MI, those with ECG-based unrecognised MI and those without MI. The participants were followed-up for incident heart failure, death or end of the study period on 12 October 2006.


RESULTS
During a median follow-up time of 13.2 years, 823 cases of heart failure occurred, of which 403 in men. Independently of cardiovascular risk factors, recognised and unrecognised MIs yielded HRs of developing heart failure in men of 2.6 (95% CI 2.0 to 3.3) and 2.1 (95% CI 1.5 to 2.9), respectively. In women, recognised MI was associated with heart failure (HR=2.8; 95% CI 1.9 to 4.1), whereas unrecognised MI was not significantly related to the risk of heart failure (HR=1.1; 95% CI 0.7 to 1.7).


CONCLUSIONS
Unrecognised MI detected by electrocardiography yields a long-term risk of heart failure equivalent to recognised MI in men, but is not significantly related to heart failure in women. In the light of the high incidence of both unrecognised MI and heart failure in the elderly, it may be worthwhile for both doctors and patients to improve responsiveness to typical and atypical symptoms of MI.
Leening
Maarten J G
MJ
Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
Elias-Smale
Suzette E
SE
Felix
Janine F
JF
Kors
Jan A
JA
Deckers
Jaap W
JW
Hofman
Albert
A
Stricker
Bruno H Ch
BH
Witteman
Jacqueline C M
JC
D000368:Aged; D004562:Electrocardiography; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D012737:Sex Factors