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May 8, 2026Journal of the American College of Cardiology

Declining In-Hospital Mortality and Increasing Heart Failure Incidence in Elderly Patients With First Myocardial Infarction

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Why the study?

Limited data exist concerning the long-term incidence or prognosis of HF after MI, particularly in the era of coronary revascularization.

Population

7,733 patients ≥ 65 years of age hospitalized for a first MI without prior HF

Design

Population-based cohort study

Follow-up

5 years

Authors

JEJustin A. EzekowitzPKPadma KaulJBJeffrey A. Bakal

Discussion

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Overview

May warrant intensified HF prevention in elderly MI survivors; leaves open most effective strategies despite revascularization advances.

Key Points

  • To determine the 5-year incidence and prognostic impact of heart failure among elderly patients hospitalized for a first myocardial infarction.
  • Conducted a population-based cohort study of 7,733 patients aged ≥65 years hospitalized with a first myocardial infarction and no prior heart failure history in Alberta, Canada (1994–2000).
  • Monitored patients over a 5-year follow-up period to evaluate rates of post-infarct heart failure and long-term all-cause mortality.
  • During the index hospitalization, 37% (n=2,831) developed heart failure and 13% (n=1,024) died; among 4,291 survivors without initial heart failure, 71% (n=3,040) developed heart failure within 5 years.
  • Five-year mortality was significantly higher among index survivors with in-hospital heart failure (39.1%) compared to those without in-hospital heart failure (26.7%, p < 0.0001).
  • Over the study period, overall 5-year mortality after myocardial infarction declined by 28%, whereas the 5-year incidence of heart failure rose by 25%.

Structured PICO

P
Population
7,733 patients ≥ 65 years of age hospitalized for a first myocardial infarction (ICD-9-CM code 410.x) without a prior history of heart failure, established between 1994 and 2000 in Alberta, Canada.
O
Outcome
Long-term incidence of heart failure and mortality over 5 yearshard clinical

In elderly patients surviving a first myocardial infarction, the long-term incidence of heart failure is extremely high (76% over 5 years) and is increasing over time as in-hospital mortality rates decline.

Cite This Study

Ezekowitz et al. (2008) studied this question.

synapsesocial.com/papers/69fd56239d16c71bcbe2233chttps://doi.org/10.1016/j.jacc.2008.08.067
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