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Long term prognosis of heart failure after acute coronary syndromes without ST elevation

¹ Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London, UK
² Division of Cardiology, EPICORE Centre, University of Alberta, Edmonton, Canada
³ Barnet and Chase Farm NHS Trust, London, UK
⁴ National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, London, UK

Correspondence to:
Correspondence to:
Dr M Flather
Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK; m.flather{at}rbh.nthames.nhs.uk

Background: Information about long term outcomes of patients with acute coronary syndromes (ACS) who have clinically diagnosed heart failure is scarce.

Methods: In a UK registry, this study evaluated patients with non-ST elevation ACS, recording treatment, and clinical outcomes for six months. In a subgroup, a four year mortality follow up was performed to estimate the impact of the clinical diagnosis of heart failure on survival.

Results: Of 1046 patients, 139 (13%) had a history of clinically diagnosed heart failure. At discharge, ACE inhibitors were prescribed for 58% and 28%, of those with and without a history of heart failure respectively (p<0.001). Rates of angiography, percutaneous intervention, and coronary artery bypass graft were 17.3% and 29.2% (p = 0.003), 5.0% and 8.4% (p = 0.17), and 5.0% and 7.5% (p = 0.3) for these groups respectively. Death or new myocardial infarction at six months occurred in 22% and 10% (p<0.001) and at four years death occurred in 60% and 20% of these groups respectively (p<0.001). In a multivariate analysis prior heart failure carried an odds ratio of 2.0 (p = 0.001) for death or myocardial infarction at six months and 2.4 (p<0.001) for death over four years. New heart failure was associated with an increased risk of death at six months (20% compared with 5%, p<0.001).

Conclusion: A clinical history of heart failure carries a substantial risk of death in patients admitted with ACS without ST elevation. Nearly 60% of those with prior heart failure are dead after four years. After adjustment for confounding factors, prior heart failure more than doubles the risk compared with those with no history.

Abbreviations: CABG, coronary artery bypass graft; ACS, acute coronary syndrome; PCI, percutaneous intervention; MI, myocardial infarction

Keywords: acute coronary syndromes; epidemiology; heart failure

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