This article is more than 5 years old. Information may no longer be current.
Incidence of HF after acute MI declined from 1998 to 2010
Hospitalization for HF after acute MI declined from 1998 to 2010, but survival after HF following acute MI remains poor, according to a new analysis of Medicare beneficiaries.
Researchers found that 1-year mortality rates for those with HF after acute MI worsened from 2007 to 2010.
Jersey Chen, MD, MPH, and colleagues analyzed a national sample of acute MI hospitalizations (n=2,789,943) among Medicare fee-for-service beneficiaries between 1998 and 2010. Using Poisson and survival analysis models, they evaluated annual changes in subsequent HF hospitalizations and mortality in this population.
There is little data available on incidence of HF after acute MI in modern practice settings, and it is unknown whether new therapies and procedures have improved myocardial salvage following MI, according to the study background.
Hospitalizations declined
Chen, of Kaiser Permanente’s Mid-Atlantic Permanente Research Institute, Rockville, Md., and colleagues found that the number of patients hospitalized for HF within 1 year of acute MI declined from 16.1 per 100 person-years in 1998 to 14.2 per 100 person-years in 2010. They calculated a relative decline of 14.6% for HF hospitalizations after acute MI during the course of the study period (incidence RR=0.854; 95% CI, 0.809-0.901), after adjusting for demographic factors.
“One potential explanation for this finding is that improvements in myocardial salvage and more complete revascularization after [acute MI] occurred during this time, which resulted in fewer subsequent HF events,” Chen and colleagues wrote. “… Another possible reason is increased use of [acute MI] pharmacotherapies that reduce adverse ventricular remodeling … and neuro-horomonal activation … thus reducing subsequent HF events.” Increased surveillance of HF in outpatient settings may also be a factor, they wrote.
While the decline in hospitalization rates occurred across all race and sex groups, blacks and women maintained higher incidence of HF after acute MI than the other groups.
1-year morality increasing
Unadjusted 1-year mortality rates following HF hospitalization after acute MI were 44.4% in 1998, 43.2% in 2004-2005 and 45.5% in 2010. After adjusting for demographic factors and clinical comorbidities, the researchers calculated a 2.4% relative annual decrease from 1998 to 2007 (HR=0.976; 95% CI, 0.974-0.978) and a 5.1% relative annual increase from 2007 to 2010 (HR=1.051; 95% CI, 1.039-1.064).
These findings could also be explained by improvements in treatment for acute MI, Chen and colleagues wrote.
“Improvements in [acute MI] care that decreased development of HF may have translated into decreased mortality in the beginning of the study period, followed by increasing mortality, if only the most severely ill HF patients were admitted in the latter half of the decade,” they wrote. “It is possible that mortality from HF after [acute MI] has worsened in recent years, but this is not consistent with the improvements in [acute MI] care… Alternatively, mortality may have increased due to higher atherosclerotic burden or increased severity of comorbidities over time. For example, the prevalence of renal failure increased more than three-fold over the study period.”
Disclosure: One researcher reports financial ties with Medtronic and UnitedHealth.