Predictors of the first heart failure hospitalization in patients who are stable survivors of myocardial infarction complicated by pulmonary congestion and/or left ventricular dysfunction: A VALIANT study

Eldrin F. Lewis, Eric J. Velazquez, Scott D. Solomon, Anne S. Hellkamp, John J V McMurray, Jasmine Mathias, Jean Lucien Rouleau, Aldo P. Maggioni, Karl Swedberg, Lars Kober, Harvey White, Anthony J. Dalby, Gary S. Francis, Faiez Zannad, Robert M. Califf, Marc A. Pfeffer

Research output: Contribution to journalArticlepeer-review

64 Scopus citations

Abstract

Aims: We sought to assess the incidence of and prognostic factors for heart failure (HF) hospitalization among survivors of high-risk acute myocardial infarction (MI). Methods and results: We assessed the risk of an initial hospitalization for HF in 11 040 stable MI patients (no major non-fatal cardiovascular events or deaths within 45 days of randomization) without a prior history of HF enrolled in the VALIANT trial. Multivariable models were developed to identify independent predictors of HF and HF or cardiovascular death. Of 11 040 stable post-MI patients, 1139 (10.3%) developed HF during the median 25-month follow-up at a rate of ∼3.4% per year. Most patients, 824 (72.3%), did not have a symptomatic recurrent MI between randomization and the onset of HF. The most important predictors of HF were older age, antecedent diabetes, prior MI before index MI, and reduced renal function. HF markedly increased the risk of death [HR(hazard ratio) 8.22; 95% CI(confidence interval), 7.49-9.01]. Conclusion: HF post high risk-MI occurs in a time-dependent fashion and is usually not directly related to re-infarction. Patients who experience HF beyond the acute phase have increased mortality. Long-term survivors of high-risk MI should be followed closely and treated aggressively beyond the acute MI period.

Original languageEnglish (US)
Pages (from-to)748-756
Number of pages9
JournalEuropean heart journal
Volume29
Issue number6
DOIs
StatePublished - Mar 2008

Bibliographical note

Funding Information:
VALIANT was funded by Novartis Pharmaceuticals. Most co-authors have received grant support to conduct the study.

Keywords

  • Heart failure
  • Hospitalization
  • Mortality
  • Myocardial infarction
  • Predictors

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