title: In-hospital management and outcomes of acute coronary syndromes in relation to prior history of heart failure.
abstract: BACKGROUND
  The prognostic significance of prior heart failure in acute coronary syndromes has not been well studied. Accordingly, we evaluated the baseline characteristics, management patterns and clinical outcomes in patients with acute coronary syndromes who had prior heart failure.
  
  
  RESULTS
  The study population consisted of acute coronary syndrome patients in the Global Registry of Acute Coronary Events, expanded Global Registry of Acute Coronary Events and Canadian Registry of Acute Coronary Events between 1999 and 2008. Of the 13,937 eligible patients (mean age 66±13 years, 33% female and 28.3% with ST-elevation myocardial infarction), 1498 (10.7%) patients had a history of heart failure. Those with prior heart failure tended to be older, female and had lower systolic blood pressure, higher Killip class and creatinine on presentation. Prior heart failure was also associated with significantly worse left ventricular systolic function and lower rates of cardiac catheterization and coronary revascularization. The group with previous heart failure had significantly higher rates of acute decompensated heart failure, cardiogenic shock, myocardial (re)infarction and mortality in hospital. In multivariable analysis, prior heart failure remained an independent predictor of in-hospital mortality (odds ratio 1.48, 95% confidence interval 1.08-2.03, p=0.015).
  
  
  CONCLUSIONS
  Prior heart failure was associated with high risk features on presentation and adverse outcomes including higher adjusted in-hospital mortality in acute coronary syndrome patients. However, acute coronary syndrome patients with prior heart failure were less likely to receive evidence-based therapies, suggesting potential opportunities to target more intensive treatment to improve their outcome.
authors.affiliation: Terrence Donnelly Heart Centre, St. Michael's Hospital, Canada University of Toronto, Canada.
authors.forename: Hanfei
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Terrence Donnelly Heart Centre, St. Michael's Hospital, Canada University of Toronto, Canada Canadian Heart Research Centre, Canada.
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.affiliation: University of Toronto, Canada.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Yan
authors.affiliation: DHU FIRE, Université Paris-Diderot, AP-HP, Hôpital Bichat, France.
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Fraser Health Authority, Canada.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Kornder
authors.affiliation: Mazankowski Alberta Heart Institute, University of Alberta, Canada.
authors.forename: Gabor T
authors.initials: GT
authors.lastname: Gyenes
authors.affiliation: Hôtel-Dieu de Lévis, Canada.
authors.forename: Francois R
authors.initials: FR
authors.lastname: Grondin
authors.affiliation: Coronary Care Unit, Concord Hospital, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.affiliation: Cornwall Community Hospital, Cornwall and University of Ottawa, Canada.
authors.forename: J Paul
authors.initials: JP
authors.lastname: DeYoung
authors.affiliation: Montreal Heart Institute, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Gallo
authors.affiliation: Terrence Donnelly Heart Centre, St. Michael's Hospital, Canada University of Toronto, Canada yana@smh.ca.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D011379:Prognosis; D012042:Registries; D012737:Sex Factors
keywords: Acute heart failure; acute coronary syndrome; chronic heart failure; outcomes