Risk and predictors of readmission for heart failure following a myocardial infarction between 2004 and 2013: A Swedish nationwide observational study

Desta, Liyew; Jernberg, Tomas; Spaak, Jonas; Hofman-Bang, Claes; Persson, Hans

doi:10.1016/j.ijcard.2017.05.086

Cited by 40 publications

(37 citation statements)

References 33 publications

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“…Age, atrial fibrillation and diabetes were independent predictors of developing HF on multivariable analysis. These findings are concordant with previous studies …”

Section: Participants Methods and Resultssupporting

confidence: 94%

Heart failure admissions following ST segment elevation myocardial infarction

Ezad

Al-Omary

Davies

et al. 2019

Australian J Rural Health

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The incidence of acute myocardial infarction (AMI) has fallen by 23% over the past 20 years in the Hunter New England Local Health district (HNELHD), 1 which covers an area of over 130 000 km 2 and has a single 24-hour primary percutaneous intervention (PCI) centre serving a population of over 900 000. This geographical area is comparable to England in size, which has 69 primary PCI centres. Travel time to our PCI centre can be up to five hours. Therefore, in patients whom the estimated time to PCI centre is greater than 60 min, thrombolysis is preferred. The falling incidence of AMI in Australia seems to be primarily driven by a 30% decline in ST-elevation myocardial infarction (STEMI). 2 During a similar time period, mortality following AMI has also decreased across Australia. 3 Despite the falling incidence and reduced mortality following AMI, we have shown an increase in total heart failure (HF) hospitalisations in the HNELHD. 4 While population growth and ageing partly explain these findings, controversy exists as to whether the improved survival postAMI is contributing to the HF epidemic.In the context of these temporal trends of AMI and HF, the rate of HF admission in patients who have suffered STEMI has not been well defined in a contemporary population. We sought to evaluate this relationship and define characteristics that might predict patients at high risk of being readmitted with HF following STEMI.

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“…Age, atrial fibrillation and diabetes were independent predictors of developing HF on multivariable analysis. These findings are concordant with previous studies …”

Section: Participants Methods and Resultssupporting

confidence: 94%

Heart failure admissions following ST segment elevation myocardial infarction

Ezad

Al-Omary

Davies

et al. 2019

Australian J Rural Health

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“…This trend has been previously described and can be explained by improved revascularization treatment, and improved primary and secondary prevention [19]. Recently published papers support our findings showing that the risk for late-onset HF after MI has decreased the last 15 years, probably due to better secondary preventive treatment and reduced burden of comorbidities [20,21].…”

Section: Patientssupporting

confidence: 89%

Reorganization of heart failure management and improved outcome – the 4D HF Project

Matan

Löfström

Cabrera

et al. 2020

Scandinavian Cardiovascular Journal

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Objectives. Heart failure (HF) management is suboptimal in Sweden despite available evidence-based guidelines. To improve HF treatment, a comprehensive HF management program (4D project) was implemented in the Stockholm County (>2.1 million inhabitants). Design. A standardized care program centralized at five hospital-based HF clinics was implemented in 2014-2017. We registered from 2012 to 2017: (1) numbers of referrals and visits to HF clinics, (2) numbers of hospital admitted patients per million inhabitants, (3) dispensed HF medications after admission, and (4) covariate-adjusted 1-year allcause mortality or HF readmission. Results. Yearly visits to the five HF outpatient clinics increased 3.4 times from 3,372 to 11,527. Dispensed HF drug prescriptions increased, in particular, for readmitted patients, compared to 2012 (p<.0001). Total number of hospital admitted HF patients as well as newonset or readmitted HF patients decreased by 16, 13, and 20%, respectively (p < .0001). The combined 1year mortality or HF readmission over the period was 48% (n ¼ 17,124/35,880) and improved per year (HR 0.98 [0.97-0.99], p < .001) from 2012. Conclusion. A comprehensive standardized care HF management program including expanded HF clinics was associated with improved evidence-based medication, reduced HF hospitalization, and improvement of the combined outcome of 1-year mortality or HF readmission in Stockholm.

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“… 19 This decline is confirmed further by a national Swedish hospital discharge and death registry study reporting a one-third decline in incidence between 1993 and 2004. 20 The same Swedish group recently reported that this trend persists for the period 2004–2013 2 and showed improved pharmacological treatment and early revascularisation in this period. During a median follow-up of 4 years, 19% of the patients were rehospitalised because of HF.…”

Section: Discussionmentioning

confidence: 92%

“… 1 More recently, a Swedish study found a 5-year cumulative risk of HF after MI of 21.8% in the calendar period 2004–2013. 2 Further, a Danish nationwide cohort study reported an incidence of HF at 90 days following MI of 19.6% in 2009–2010. 3 Differences between these studies could be related to a number of factors, for example, change in treatment, national policies or definitions of HF, all of which potentially limit the generalisability of results.…”

Section: Introductionmentioning

confidence: 99%

An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors

et al. 2018

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ObjectivesTo investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of patients with MI using routinely collected primary and hospital care electronic health records (EHRs).MethodsData were used from the CALIBER programme, linking EHRs in England from primary care, hospital admissions, an MI registry and mortality data. Subjects were eligible if they were 18 years or older, did not have a history of HF and survived a first MI. Factors associated with time to HF were examined using Cox proportional hazard models.ResultsOf the 24 479 patients with MI, 5775 (23.6%) developed HF during a median follow-up of 3.7 years (incidence rate per 1000 person-years: 63.8, 95% CI 62.2 to 65.5). Baseline characteristics significantly associated with developing HF were: atrial fibrillation (HR 1.62, 95% CI 1.51 to 1.75), age (per 10 years increase: 1.45, 1.41 to 1.49), diabetes (1.45, 1.35 to 1.56), peripheral arterial disease (1.38, 1.26 to 1.51), chronic obstructive pulmonary disease (1.28, 1.17 to 1.40), greater socioeconomic deprivation (5th vs 1st quintile: 1.27, 1.13 to 1.41), ST-segment elevation MI at presentation (1.19, 1.11 to 1.27) and hypertension (1.16, 1.09 to 1.23). Results were robust to various sensitivity analyses such as competing risk analysis and multiple imputation.ConclusionIn England, one in four survivors of a first MI develop HF within 4 years. This contemporary study demonstrates that patients with MI are at considerable risk of HF. Baseline patient characteristics associated with time until HF were identified, which may be used to target preventive strategies.

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Risk and predictors of readmission for heart failure following a myocardial infarction between 2004 and 2013: A Swedish nationwide observational study

Cited by 40 publications

References 33 publications

Heart failure admissions following ST segment elevation myocardial infarction

Heart failure admissions following ST segment elevation myocardial infarction

Reorganization of heart failure management and improved outcome – the 4D HF Project

An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors

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