Management and outcomes following an acute coronary event in patients with chronic heart failure 19992007

Isuru Ranasinghe, Chris Naoum, Bernadette Aliprandi-Costa, Andrew P. Sindone, Philippe Gabriel Steg, John Francis Elliott, Bruce McGarity, Jeffrey Lefkovits, David Brieger

Research output: Contribution to journalReview ArticleResearchpeer-review

7 Citations (Scopus)

Abstract

Aim The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time. Method and results A total of 5556 patients enrolled in the AustraliaNew Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included. Patients with CHF (n = 609) were compared with those without CHF (n = 4947). Patients with CHF were on average 10 years older, were more likely to be female, had more co-morbidities and cardiac risk factors, and were more likely to have a prior history of angina, myocardial infarction, and revascularization by coronary artery bypass graft (CABG) when compared with those without CHF. CHF was associated with a substantial increase in in-hospital renal failure [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.15-2.71], readmission post-discharge (OR 1.47, 95% CI 1.17-1.90), and 6-month mortality (OR 2.25, 95% CI 1.55-3.27). Over the 9 year study period, in-hospital and 6 month mortality in those with CHF declined by absolute rates of 7.5% and 14%, respectively. This was temporally associated with an increase in prescription of thienopyridines, beta-blockers, statins, and angiotensin II receptor blockers, increased rates of coronary angiography, and 31.8% absolute increase in referral rates for cardiac rehabilitation. Conclusion sAcute coronary syndrome patients with pre-existing CHF are a very high risk group and carry a disproportionate mortality burden. Encouragingly, there was a marked temporal improvement in outcomes over a 9 year period with an increase in evidence-based treatments and secondary preventative measures.

Original languageEnglish
Pages (from-to)464-472
Number of pages9
JournalEuropean Journal of Heart Failure
Volume14
Issue number5
DOIs
Publication statusPublished - May 2012
Externally publishedYes

Keywords

  • Acute coronary syndromes
  • Epidemiology
  • Heart failure
  • Outcomes research

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