Twenty year trends (1975-1995) in the incidence, in-hospital and long-termdeath rates associated with heart failure complicating acute myocardial infarction - A community-wide perspective

OBJECTIVES: To describe from a population-based perspective, recent and tem poral (1975-1995) trends in the incidence, in-hospital and postdischarge ca se-fatality rates of heart failure (HF) complicating acute myocardial infar ction (AMI). BACKGROUND: Extremely limited data are available describing the incidence a nd case-fatality rates associated with HF complicating AMI from a community -wide perspective. METHODS: The medical records of 6,798 residents of the Worcester, Massachus etts metropolitan area with validated MI and without previous HF hospitaliz ed in 10 annual periods between 1975 and 1995 were reviewed. RESULTS: The proportion of AMI patients developing HF during hospitalizatio n declined between 1975-1978 (38%) and 1993-1995 (33%) (p < 0.001). After c ontrolling for potentially confounding factors, the risk of developing HF d eclined progressively, albeit modestly, over time. in-hospital case-fatalit y rates of patients with AMI complicated by HF declined by approximately 46 % between 1975-1978 (33%) and 1993-1995 (18%) (p < 0.001). Improving trends in hospital survival were observed after adjusting for potentially confoun ding prognostic factors. The one-par post-discharge mortality rate for hosp ital survivors of HF did not change over the 20-year period under study, ev en after controlling for additional prognostic characteristics. CONCLUSIONS: The results of this community-wide study suggest encouraging d eclines in the incidence and hospital death rates associated with HF compli cating AMI. Continued efforts need to be directed towards the prevention of HF given the magnitude of this clinical syndrome. Efforts of secondary pre vention are needed to identify and improve the treatment of patients with s ymptomatic left ventricular dysfunction following AMI given the lack of imp rovement in the long term prognosis of these patients. (C) 1999 by the Amer ican College of Cardiology.