title: Incidence of heart failure and mortality after acute coronary syndromes.
abstract: BACKGROUND
  The long-term incidence of heart failure (HF) in ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina (UA) patients is uncertain. We examined the 1-year incidence of HF and its association with mortality among patients surviving their first acute coronary syndrome (ACS) hospitalization.
  
  
  RESULTS
  A retrospective cohort study of patients, aged ≥20 years, with no prior HF, hospitalized for the first time with ACS between April 1, 2002, and December 31, 2008, in Alberta, Canada, and followed up for 1 year. Index HF was defined as HF that developed as a complication during the index ACS hospitalization, and post-discharge HF, as HF developing after discharge from the index ACS hospitalization. Among 9,406 STEMI, 11,008 NSTEMI, and 4,910 UA patients, 13.6%, 14.8%, and 5.2% had index HF, respectively (P < .01). At 1-year, cumulative HF rates were 23.4% in STEMI, 25.4% in NSTEMI, and 16% in UA patients. Among hospital survivors, 1-year mortality rate was 13.9% in patients with index HF, 10.6% in patients with postdischarge HF, and 2.4% in patients with no HF. In multivariable analysis, both index HF (adjusted hazard ratio 3.2, 95% CI 2.7-3.7) and postdischarge HF (adjusted hazard ratio 4.6, 95% CI 3.9-5.4) were associated with 1-year mortality.
  
  
  CONCLUSIONS
  There are significant differences in the incidence of HF among STEMI, NSTEMI, and UA patients. The increased mortality risk associated with index HF and postdischarge HF suggests a need for vigilant follow-up of all ACS patients for prompt detection and treatment of HF.
authors: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. pkaul@ualberta.ca
authors: Padma
authors: P
authors: Kaul
authors: Justin A
authors: JA
authors: Ezekowitz
authors: Paul W
authors: PW
authors: Armstrong
authors: Becky K
authors: BK
authors: Leung
authors: Anamaria
authors: A
authors: Savu
authors: Robert C
authors: RC
authors: Welsh
authors: Hude
authors: H
authors: Quan
authors: Merril L
authors: ML
authors: Knudtson
authors: Finlay A
authors: FA
authors: McAlister
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate