Incidence, Risk Factors, and Outcomes of Heart Failure After Acute Myocardial Infarction: A Nationwide Study in Korea

Objective: Heart failure (HF) is a major complication of myocardial infarction (MI) that contributes to increased morbidity and mortality. Although previous studies have reported the incidence of HF following acute MI, comprehensive epidemiological and clinical data on the Korean population are lacking. This study aimed to evaluate the incidence, risk factors, and long-term outcomes of HF after MI using nationwide data. Methods: A retrospective cohort study was conducted using data from the Korean National Health Insurance Database. A total of 258,916 patients aged ≥ 18 years who were newly hospitalized for MI between 2010 and 2021 were included, excluding those with a history of MI or HF within the previous 3 years. The incidence of HF and all-cause mortality were measured. Cox proportional hazard models were used to identify the independent risk factors for HF development. Results: Among the study participants, 36,538 (14.1%) developed HF during follow-up. The cumulative incidence of HF were 7.2%, 10.2%, and 12.3% at 1, 2, and 3 years after MI, respectively. The median time of admission for HF was 431 d after MI. Older age, female sex, lower socioeconomic status, and comorbidities (such as hypertension, diabetes mellitus, dyslipidemia, stroke, and end-stage renal disease) have been shown to be significant predictors of HF development. Patients who developed HF exhibited a remarkably poor prognosis, with a 3-year cumulative probability of all-cause mortality of 37.8% compared to 21.9% in those without HF. Conclusion: HF is a frequent and critical consequence of MI and contributes to a poor long-term prognosis. Identifying patients who are at high risk and then implementing targeted interventions are essential to reduce the HF burden and improve long-term outcomes.