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

摘要

Objectives: To investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of MI patients using routinely collected primary and hospital care electronic health records. Methods: Data were used from the CALIBER programme, linking electronic health records 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. Results: Of the 24,479 MI patients 5,775 (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 – 65.5). Baseline characteristics significantly associated with developing HF were: atrial fibrillation [HR 1.62, 95% CI 1.51 – 1.75], age [per 10 years increase: 1.45, 1.41 – 1.49], diabetes [1.45, 1.35 – 1.56], peripheral arterial disease [1.38, 1.26 – 1.51], COPD [1.28, 1.17 – 1.40], greater socioeconomic deprivation [5th vs. 1st quintile 1.27, 1.13 – 1.41], ST-segment elevation MI at presentation [1.19, 1.11 – 1.27], and hypertension [1.16, 1.09 – 1.23]. Results were robust to various sensitivity analyses such as competing risk analysis and multiple imputation. Conclusion: In England, one in four survivors of a first MI develop HF within four years. This contemporary study demonstrates MI patients are at considerable risk of HF. Baseline patient characteristics associated with time till HF were identified, which may be used to target preventive strategies.