Incidence, temporal trends and prognostic impact of heart failure complicating acute myocardial infarction in the SWEDEHEART registry:

Transcription

1 Incidence, temporal trends and prognostic impact of heart failure complicating acute myocardial infarction in the SWEDEHEART registry: A study of patients from admitted with an index myocardial infarction Liyew Desta 1, Tomas Jernberg 2, Ida Löfman 2, Claes Hofman-Bang 1, Inger Hagerman 2, Jonas Spaak 1, Hans Persson 1. 1 Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden. 2 Department of Cardiology, Karolinska University Hospital, Huddinge, Stockholm.

2 Nothing to disclose

3 Background Epidemiological features IHD is known as a principal cause of HF. Remarkable changes have taken place in the contributing factors to the incidence of HF. This includes tremondous advances in the treatment practices of ACS. Understanding the epidemiology of HF requires investigation of HF in the setting of AMI. However, there is a paucity of data on temporal trends and prognostic significance of post-mi HF.

4 Conflicting evidence Literature Period N= Trend in post-mi HF Framingham no Published Circulation 1999;100: Framingham Circulation 2008;118: Ezekowitz et al J Am Coll Cardiol. 2009;53:13-20 WHAS1 (Spencer et al) J Am Coll Cardiol. 1999;34: WHAS2 (Goldberg et al) J Am Coll Cardiol. 2004;94: Hellerman et al Am J Epidemiol. 2003;157: Najafi et al Eur J Heart Fail. 2007;9: Shafazand et al Eur J Heart Fail 2011;13: Stöd vår forskning -

5 Thus data on post-mi HF, which are critical to characterization of the contribution of acute MI to the HF epidemic, are currently incomplete warranting the need for our study.

6 Aims: To examine temporal trends in incidence and outcome of heart failure (HF) complicating acute myocardial infarction (AMI).

7 Design, setting and participants: The nationwide coronary care unit registry SWEDEHEART records baseline characteristics, treatments and outcome of consecutive patients with AMI admitted to all hospitals in Sweden. The study includes patients admitted for an index AMI between 1996 and 2008.

8 SWEDEHEART (RIKS-HIA) Include all patients with an AMI at all CCU/ICU in Sweden N = patients National Outcome Registries (National Board of Health and Welfare) Hospital discharge registry Death registry

9 Definition: For the purpose of our study, the diagnosis of HF required: the presence of crackles (Killip class) or use of iv diuretics or use of iv inotropic drugs.

10 Results - demographics Age, y 70,2 71,2 71,3 70,8 Females (%) 35,0 36,8 37,0 37,1 Diabetes (%) 18,9 19,7 19,3 19,1 Hypertension (%) 32,5 35,1 40,9 47 Smokers (%) 21,7 22,4 23,9 23,0 Reperfusion treatment in STEMI pat (%) Medications at discharge (%) 62,8 63,1 63,3 77,1 Beta-blocker 75,0 80,3 84,0 86,5 ACE-I/ARB 36,9 42,8 55,3 68,1 Statins 21,5 47,7 68,3 80,6

11 The incidence of clinical HF during admission for AMI % % STEMI ARR = 22% Clinical HF ARR =18% 28% NSTEMI ARR = 14% p<0.001 for

12 The incidence of pulmonary rales by their grades over the years in the SWEDEHEART registry % Basal Half chest Pulmonary edema

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14 Pattern of LV dysfunction over the years in the RIKS- HIA population as measured by EF (all AMI) <30 normal %

15 Proportion of HF patients post AMI with HFNEF is steadily increasing EF >=50% ( HF-Yes) N= N= N= N= N= N= % 21,4% 23,1% 25,6% 28,8% 30,1%

16 HR 3.11 (CI ) Adjusted HR 2.09 (CI ) Mortality rate of patients with clinical heart failure complicating acute myocardial infarction during admission observation over 13 years period

17 Mortality rate trends in HF complicating AMI in the SWEDEHEART registry p-value In-hospital mortality 30 days mortality 1 year mortality 19 % 13% < % 17% < % 31% <0.001

18 Conclusion: We found a marked decrease in the incidence of HF complicating AMI between 1996 and This is accompanied by a significant decrease in in-hospital, 30 day and 1 year mortality. The long-term outcome in patients with HF complicating AMI is still poor

19 Thank you! Participating centres in SWEDEHEART Alingsås, Arvika, Avesta, Bollnäs, Borås, Danderyd, Eksjö, Enköping, Eskilstuna, Fagersta, Falun, Gällivare, Gävle, Halmstad, Helsingborg, Hudiksvall, Hässleholm, Jönköping, Kalix, Kalmar, Karlshamn, Karlskoga, Karlskrona, Karlstad, Karolinska, Katrineholm, Kiruna, Kristianstad, Kungälv, Köping, Landskrona, Lidköping, Lindesberg, Linköping, Ljungby, Lund, Lycksele, Malmö, Mora, Motala, Mölndal, Norrköping, Norrtälje, Nyköping, Oskarshamn, Piteå, Sahlgrenska, Skellefteå, Skövde, Sollefteå. St Göran, Sunderbyn, Sundsvall, Södersjukhuset, Södertälje, Torsby, Trelleborg, Trollhättan, Umeå, Uppsala, Varberg, Visby, Värnamo, Västervik, Västerås, Växjö, Ystad, Ängelholm, Örebro, Örnsköldsvik, Östersund, Östra TAVI

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