Impact of hospitalization for acute coronary events on subsequent mortality in patients with chronic heart failure

• AIMS: We explored the impact of having a hospital admission for an acute coronary syndrome (ACS) on the subsequent prognosis among patients with chronic heart failure (CHF). METHODS AND RESULTS: A total of 7599 patients with CHF, New York Heart Association Classes II-IV, were randomly assigned to candesartan or placebo. We assessed the risk of death after a first ACS using time-updated Cox proportional hazard models adjusted for baseline predictors. During a mean follow-up of 3.3 years, 1174 patients experienced at least one ACS. Myocardial infarction (MI) was the first ACS in 442 subjects and unstable angina (UA) in 732. After these events, 219 (49.5%) and 167 (22.8%) patients died during follow-up. The early risk of death was more pronounced after MI: 30.2% died within 30 days compared with 3.6% after UA. After an ACS event, the risk of death declined steadily over time, although 18 months after an MI the risk was still twice that of patients without an ACS. CONCLUSION: Patients with CHF, who develop an ACS, have markedly increased subsequent mortality, particularly in the early phase after an MI.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

Acute Coronary Syndrome/complications/*mortality

Age Distribution

Aged

Aged

80 and over

Angina

Unstable/complications/mortality

Angiotensin II Type 1 Receptor Blockers/therapeutic use

Benzimidazoles/therapeutic use

Chronic Disease

Double-Blind Method

Female

Heart Failure/complications/drug therapy/*mortality

Hospitalization

Humans

Male

Middle Aged

Myocardial Infarction/complications/mortality

Prognosis

Tetrazoles/therapeutic use

Publication and Content Type

ref (subject category)

art (subject category)