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Impact of hospitalization for acute coronary events on subsequent mortality in patients with chronic heart failure |
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| 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 for the CHARM Investigators, |
| Affiliation: | 1 Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2 Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK 3 Department of Cardiology, Duke University Medical Center, Durham, NC, USA 4 British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK 5 AstraZeneca LP, Wilmington, DE, USA 6 Department of Cardiology, Brigham and Women's Hospital and Harvard University, Boston, MA, USA 7 Department of Medicine, HGM-McMaster Clinic, Hamilton, Ontario, Canada |
| Abstract: | Aims: We explored the impact of having a hospital admission for anacute coronary syndrome (ACS) on the subsequent prognosis amongpatients with chronic heart failure (CHF). Methods and results: A total of 7599 patients with CHF, New York Heart AssociationClasses II–IV, were randomly assigned to candesartan orplacebo. We assessed the risk of death after a first ACS usingtime-updated Cox proportional hazard models adjusted for baselinepredictors. During a mean follow-up of 3.3 years, 1174 patientsexperienced at least one ACS. Myocardial infarction (MI) wasthe first ACS in 442 subjects and unstable angina (UA) in 732.After these events, 219 (49.5%) and 167 (22.8%) patients diedduring follow-up. The early risk of death was more pronouncedafter MI: 30.2% died within 30 days compared with 3.6% afterUA. After an ACS event, the risk of death declined steadilyover time, although 18 months after an MI the risk was stilltwice that of patients without an ACS. Conclusion: Patients with CHF, who develop an ACS, have markedly increasedsubsequent mortality, particularly in the early phase afteran MI. |
| Keywords: | Chronic heart failure Acute myocardial infarction Unstable angina pectoris Prognosis |
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