Heart failure, death risks elevated within 10 years after myocardial infarction

Nearly one in three patients with myocardial infarction (MI) develop heart failure or renal failure, while a few of them experience another MI or, worse, die within 10 years, according to a study in England.

In addition, “[t]he incidence of heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes, and depression, but not dementia or cancer, was higher than expected during the normal life course without MI,” said the researchers, led by Dr Marlous Hall of University of Leeds, Leeds, UK.

Hall presented the findings of their study at the recent ESC 2023. Together with his colleagues, they conducted this nationwide cohort study in 34,116,257 adults, which contributed a total of 145,912,852 hospitalizations between 1 January 2008 and 31 January 2017, with final follow-up on 27 March 2017.

“Information about the health outcomes of people with MI is required to determine individual health needs, enable earlier detection and treatment of new onset disease, and inform health service planning,” the researchers said.

Estimation of the risk of cardiovascular disease at 10 years has always been part of primary prevention, but not so for MI. There exists a lack of comprehensive evidence for the long-term effect of MI on subsequent major health outcomes.

“Such information is critical not only for the development of guideline recommendations, but also to underpin shared decision making,” the researchers said.

In this study, Hall and his team calculated the absolute risk of 11 nonfatal health outcomes following MI (ie, subsequent MI and new hospitalizations of heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes, dementia, depression, and cancer) and all-cause mortality using standardized cumulative incidence functions (CIFs) over a 9-year follow-up.

Flexible parametric survival models were used to estimate CIFs, with adjustments for age, sex, year, deprivation, and competing risk of death. The relative risk of incident health outcomes was determined via risk-set matching by age, sex, and year of hospitalization relative to those without MI.

Post-MI events

Of the identified participants, 433,361 had MI (mean age 67.4 years). Majority of those who had MI were males (n=286,728; 65.3 percent). [Hall M, et al, ESC 2023]

The most frequent event after MI was all-cause mortality (CIF, 37.8 percent, 95 percent confidence interval [CI], 37.6‒37.9), followed by heart failure (CIR, 29.6 percent, 95 percent CI, 29.4‒29.7), renal failure (CIF, 27.2 percent, 95 percent CI, 27.0‒27.4), atrial fibrillation (CIF, 22.3 percent, 95 percent CI, 22.2‒22.5), and severe bleeding (CIF, 19.0 percent, 95 percent CI, 18.8‒19.1).

Other events that could occur following MI were diabetes (CIF, 17.0 percent, 95 percent CI, 16.9‒17.1), cancer (CIF, 13.5 percent, 95 percent CI, 13.3‒13.6), cerebrovascular disease (CIF, 12.5 percent, 95 percent CI, 12.4‒12.7), depression (CIF, 8.9 percent, 95 percent CI, 8.7‒9.0), dementia (CIF, 7.8 percent, 95 percent CI, 7.7‒7.9), subsequent MI (CIF, 7.1 percent, 95 percent CI, 7.0‒7.2), and peripheral arterial disease (CIF, 6.5 percent, 95 percent CI, 6.4‒6.6).

Except for dementia (hazard ratio [HR], 1.01, 95 percent CI, 0.99‒1.02) and cancer (HR, 0.56, 95 percent CI, 0.56‒0.57), first hospitalization of all nonfatal health outcomes was increased following MI when compared with 2,001,301 matched controls.

“Improved post-MI preventative strategies, encompassing enhanced surveillance and detection, are required to tackle the high incidences of heart failure, atrial fibrillation, cerebrovascular disease, and renal failure observed in this population,” the researchers said.