Impact of hospitalization for acute coronary events on subsequent mortality in patients with chronic heart failure

• Published in: European heart journal Vol. 30; no. 3; pp. 338 - 345
• Main Authors: Abrahamsson, Putte, Dobson, Joanna, Granger, Christopher B., McMurray, John J.V., Michelson, Eric L., Pfeffer, Marc, Pocock, Stuart, Solomon, Scott D., Yusuf, Salim, Swedberg, Karl
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.02.2009; Oxford Publishing Limited (England)
• Subjects: 80 and over; Acute Coronary Syndrome - complications; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome/complications/mortality; Acute myocardial infarction; Age Distribution; Aged; Aged, 80 and over; Angina; Angina, Unstable - complications; Angina, Unstable - mortality; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Benzimidazoles - therapeutic use; Biological and medical sciences; Cardiology and Cardiovascular Disease; Cardiology. Vascular system; Chronic Disease; Chronic heart failure; Coronary heart disease; Double-Blind Method; Female; Heart; Heart Failure - complications; Heart Failure - drug therapy; Heart Failure - mortality; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Failure/complications/drug therapy/mortality; Hospitalization; Humans; Kardiologi och kardiovaskulära sjukdomar; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - mortality; Myocardial Infarction/complications/mortality; Myocarditis. Cardiomyopathies; Prognosis; Tetrazoles - therapeutic use; Unstable angina pectoris; Unstable/complications/mortality; Prognosis; Chronic heart failure; Acute myocardial infarction; Unstable angina pectoris; Human; Myocardial infarction; Heart failure; Acute; Mortality; Coronary artery; Cardiovascular disease; Hospitalization; Myocardial disease; Coronary heart disease; Epidemiology; Chronic; Circulatory system; Cardiology; Variant angina
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehn503

Aims We explored the impact of having a hospital admission for an acute coronary syndrome (ACS) on the subsequent prognosis among patients with chronic heart failure (CHF). Methods and results A total of 7599 patients with CHF, New York Heart Association Classes II–IV, were randomly assigned to candesartan or placebo. We assessed the risk of death after a first ACS using time-updated Cox proportional hazard models adjusted for baseline predictors. During a mean follow-up of 3.3 years, 1174 patients experienced at least one ACS. Myocardial infarction (MI) was the first ACS in 442 subjects and unstable angina (UA) in 732. After these events, 219 (49.5%) and 167 (22.8%) patients died during follow-up. The early risk of death was more pronounced after MI: 30.2% died within 30 days compared with 3.6% after UA. After an ACS event, the risk of death declined steadily over time, although 18 months after an MI the risk was still twice that of patients without an ACS. Conclusion Patients with CHF, who develop an ACS, have markedly increased subsequent mortality, particularly in the early phase after an MI.