title: Management and outcomes following an acute coronary event in patients with chronic heart failure 1999-2007.
abstract: OBJECTIVE
  The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time.
  
  
  RESULTS
  A total of 5556 patients enrolled in the Australia-New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included. Patients with CHF (n = 609) were compared with those without CHF (n = 4947). Patients with CHF were on average 10 years older, were more likely to be female, had more co-morbidities and cardiac risk factors, and were more likely to have a prior history of angina, myocardial infarction, and revascularization by coronary artery bypass graft (CABG) when compared with those without CHF. CHF was associated with a substantial increase in in-hospital renal failure [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.15-2.71], readmission post-discharge (OR 1.47, 95% CI 1.17-1.90), and 6-month mortality (OR 2.25, 95% CI 1.55-3.27). Over the 9 year study period, in-hospital and 6 month mortality in those with CHF declined by absolute rates of 7.5% and 14%, respectively. This was temporally associated with an increase in prescription of thienopyridines, beta-blockers, statins, and angiotensin II receptor blockers, increased rates of coronary angiography, and 31.8% absolute increase in referral rates for cardiac rehabilitation.
  
  
  CONCLUSIONS
  Acute coronary syndrome patients with pre-existing CHF are a very high risk group and carry a disproportionate mortality burden. Encouragingly, there was a marked temporal improvement in outcomes over a 9 year period with an increase in evidence-based treatments and secondary preventative measures.
authors.affiliation: Concord Repatriation General Hospital and The University of Sydney, Sydney, NSW, Australia.
authors.forename: Isuru
authors.initials: I
authors.lastname: Ranasinghe
authors.forename: Chris
authors.initials: C
authors.lastname: Naoum
authors.forename: Bernadette
authors.initials: B
authors.lastname: Aliprandi-Costa
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Sindone
authors.forename: P Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: John
authors.initials: J
authors.lastname: Elliott
authors.forename: Bruce
authors.initials: B
authors.lastname: McGarity
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lefkovits
authors.forename: David
authors.initials: D
authors.lastname: Brieger
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality / Q000628:therapy; D000368:Aged; D002908:Chronic Disease; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome