title: Management and Long-Term Outcome of Acute Coronary Syndrome Patients Presenting with Heart Failure in a Contemporary New Zealand Cohort (ANZACS-QI 4).
abstract: BACKGROUND
  Acute heart failure (HF) associated with an acute coronary syndrome (ACS) predicts adverse outcome. There have been important recent improvements in ACS management. Our aim was to describe the management and outcomes in those with and without HF in a contemporary ACS cohort.
  
  
  METHODS
  Consecutive patients presenting with ACS between 2007 and 2011 were enrolled in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. Outcomes and medication dispensing were obtained using anonymised linkage to national data sets. A summary pharmacotherapy measure of "quadruple therapy" was defined as dispensing of at least one agent from each of the four evidence-based classes - anti-platelet, statin, angiotensin converting enzyme inhibitor/angiotensin receptor blocker and beta blocker.
  
  
  RESULTS
  Of 3743 ACS patients 14% had acute HF. Acute heart failure patients were older (69.2±12.6 vs 62.3±12.8 years, p<0.001), less likely to have coronary angiography (66% vs 86%, p<0.001) and revascularisation (46% vs 62%, p<0.001). Immediate post-discharge quadruple therapy was higher for those with than without HF (61% vs 55%, p=0.02) but fell to similar levels by one-year (45% vs 53%, p=0.55). At four years follow-up nearly half of those presenting with ACS and HF had died. After adjustment, HF remained a strong predictor of death within 28 days (OR 2.9, 95%CI 1.5 - 5.5) and beyond 28 days (HR 1.8, 95%CI 1.5 - 2.3).
  
  
  CONCLUSIONS
  Acute heart failure complicating ACS is associated with heightened risk of short-term and long-term mortality. One in three ACS patients with HF did not have coronary angiography and less than half received quadruple therapy a year after presentation.
authors.affiliation: Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.
authors.forename: Shaw Hua Anthony
authors.initials: SH
authors.lastname: Kueh
authors.affiliation: Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.
authors.forename: Gerry
authors.initials: G
authors.lastname: Devlin
authors.affiliation: Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Medicine, University of Auckland and Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Rob N
authors.initials: RN
authors.lastname: Doughty
authors.affiliation: Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand. Electronic address: Andrew.Kerr@middlemore.co.nz.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerr
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012307:Risk Factors
keywords: Acute coronary syndrome; Cardiomyopathy; Heart failure; Myocardial infarction; Treatment outcome