Contemporary trends in heart failure with reduced and preserved ejection fraction after myocardial infarction: A community study

Yariv Gerber, Susan A. Weston, Cecilia Berardi, Sheila M. McNallan, Ruoxiang Jiang, Margaret May Redfield, Veronique Lee Roger

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Major changes have recently occurred in the epidemiology of myocardial infarction (MI) that could possibly affect outcomes such as heart failure (HF). Data describing trends in HF after MI are scarce and conflicting and do not distinguish between preserved and reduced ejection fraction (EF). We evaluated temporal trends in HF after MI. All residents of Olmsted County, Minnesota (n = 2,596) who had a first-ever MI diagnosed in 1990-2010 and no prior HF were followed-up through 2012. Framingham Heart Study criteria were used to define HF, which was further classified according to EF. Both early-onset (0-7 days after MI) and late-onset (8 days to 5 years after MI) HF were examined. Changes in patient presentation were noted, including fewer ST-segment-elevation MIs, lower Killip class, and more comorbid conditions. Over the 5-year follow-up period, 715 patients developed HF, 475 of whom developed it during the first week. The age-and sex-adjusted risk declined from 1990-1996 to 2004-2010, with hazard ratios of 0.67 (95% confidence interval (CI): 0.54, 0.85) for early-onset HF and 0.63 (95% CI: 0.45, 0.86) for late-onset HF. Further adjustment for patient and MI characteristics yielded hazard ratios of 0.86 (95% CI: 0.66, 1.11) and 0.63 (95% CI: 0.45, 0.88) for early-and late-onset HF, respectively. Declines in early-onset and late-onset HF were observed for HF with reduced EF (<50%) but not for HF with preserved EF, indicating a change in the case mix of HF after MI that requires new prevention strategies.

Original languageEnglish (US)
Pages (from-to)1272-1280
Number of pages9
JournalAmerican Journal of Epidemiology
Volume178
Issue number8
DOIs
StatePublished - Oct 15 2013

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Heart Failure
Myocardial Infarction
Confidence Intervals
Diagnosis-Related Groups
Epidemiology

Keywords

  • cardiovascular diseases
  • community studies
  • ejection fraction
  • heart failure
  • myocardial infarction
  • population-based studies
  • secular trends
  • surveillance

ASJC Scopus subject areas

  • Epidemiology

Cite this

Contemporary trends in heart failure with reduced and preserved ejection fraction after myocardial infarction : A community study. / Gerber, Yariv; Weston, Susan A.; Berardi, Cecilia; McNallan, Sheila M.; Jiang, Ruoxiang; Redfield, Margaret May; Roger, Veronique Lee.

In: American Journal of Epidemiology, Vol. 178, No. 8, 15.10.2013, p. 1272-1280.

Research output: Contribution to journalArticle

Gerber, Yariv ; Weston, Susan A. ; Berardi, Cecilia ; McNallan, Sheila M. ; Jiang, Ruoxiang ; Redfield, Margaret May ; Roger, Veronique Lee. / Contemporary trends in heart failure with reduced and preserved ejection fraction after myocardial infarction : A community study. In: American Journal of Epidemiology. 2013 ; Vol. 178, No. 8. pp. 1272-1280.
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abstract = "Major changes have recently occurred in the epidemiology of myocardial infarction (MI) that could possibly affect outcomes such as heart failure (HF). Data describing trends in HF after MI are scarce and conflicting and do not distinguish between preserved and reduced ejection fraction (EF). We evaluated temporal trends in HF after MI. All residents of Olmsted County, Minnesota (n = 2,596) who had a first-ever MI diagnosed in 1990-2010 and no prior HF were followed-up through 2012. Framingham Heart Study criteria were used to define HF, which was further classified according to EF. Both early-onset (0-7 days after MI) and late-onset (8 days to 5 years after MI) HF were examined. Changes in patient presentation were noted, including fewer ST-segment-elevation MIs, lower Killip class, and more comorbid conditions. Over the 5-year follow-up period, 715 patients developed HF, 475 of whom developed it during the first week. The age-and sex-adjusted risk declined from 1990-1996 to 2004-2010, with hazard ratios of 0.67 (95{\%} confidence interval (CI): 0.54, 0.85) for early-onset HF and 0.63 (95{\%} CI: 0.45, 0.86) for late-onset HF. Further adjustment for patient and MI characteristics yielded hazard ratios of 0.86 (95{\%} CI: 0.66, 1.11) and 0.63 (95{\%} CI: 0.45, 0.88) for early-and late-onset HF, respectively. Declines in early-onset and late-onset HF were observed for HF with reduced EF (<50{\%}) but not for HF with preserved EF, indicating a change in the case mix of HF after MI that requires new prevention strategies.",
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