Influence of heart failure symptoms and ejection fraction on short- and long-term outcomes for older patients with non-ST-segment elevation myocardial infarction.
BACKGROUND
Symptomatic heart failure (HF) and reduced ejection fraction (REF) are both associated with mortality, but the long-term outcomes associated with the development of HF in older non-ST-segment elevation myocardial infarction (NSTEMI) patients with preserved systolic function and REF are uncertain.


METHODS
We analyzed a total of 26,291 NSTEMI patients ≥65 years discharged alive in the CRUSADE Registry who had linked Medicare data. We evaluated 30-day and 1-year risks of mortality and HF readmission in 4 cohorts of patients stratified by symptomatic HF and ejection fraction: (1) no HF-PEF, (2) no HF-REF, (3) HF-PEF, and (4) HF-REF.


RESULTS
A total of 14,280 NSTEMI patients (54.3%) had no HF-PEF, 3,345 (12.7%) had no HF-REF, 4,913 (18.7%) had HF-PEF, and 3,753 (14.3%) had HF-REF. Compared with no HF-PEF patients, the 30-day mortality risk was higher among patients with no HF-REF (4.9% vs 1.7%, adjusted hazard ratio 2.11, 95% CI 1.69-2.63), HF-PEF (5.9% vs 1.7%, adjusted hazard ratio 1.99, 95% CI 1.64-2.41), and highest among those with HF-REF (9.3% vs 1.7%, adjusted hazard ratio 2.70, 95% CI 2.23-3.26). Similar relationships were noted in the adjusted 1-year mortality and the risks of 30-day and 1-year HF readmission.


CONCLUSIONS
Symptomatic HF and REF during the index NSTEMI hospitalization are both associated with an increased risk of short- and long-term mortality as well as HF readmission with an apparent additive prognostic impact of both factors.
Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: sv9@ualberta.ca.
Sean
S
van Diepen
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Anita Y
AY
Chen
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Tracy Y
TY
Wang
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Karen P
KP
Alexander
Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
Justin A
JA
Ezekowitz
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Eric D
ED
Peterson
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Matthew T
MT
Roe
D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology