March 4, 2022Expert Review of Cardiovascular Therapy

Management and outcomes of acute myocardial infarction in patients with preexisting heart failure: an analysis of 2 million patients from the national inpatient sample

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Why the study?

Inpatient management and outcomes of patients presenting with acute myocardial infarction with a history of heart failure have not been well characterized.

Does preexisting heart failure impact the utilization of invasive management and in-hospital mortality in patients presenting with acute myocardial infarction?

Structured PICO

Does preexisting heart failure impact the utilization of invasive management and in-hospital mortality in patients presenting with acute myocardial infarction?

Population

2,434,639 hospitalizations for acute myocardial infarction (AMI) from the US Nationwide Inpatient Sample (2015–2018).

Intervention

Preexisting diagnosis of heart failure with preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF)

Comparator

Absence of preexisting heart failure

Outcome

Utilization of invasive management (coronary angiography and PCI) and in-hospital mortalityhard clinical

Preexisting heart failure in patients presenting with acute myocardial infarction is associated with a lower likelihood of receiving invasive procedures and a higher risk of in-hospital mortality.

Implication

Preexisting HF in AMI was associated with higher mortality and less invasive care; leaves open whether targeted strategies improve outcomes.

Abstract

Background Inpatient management and outcomes of patients presenting with acute myocardial infarction (AMI) with a history of heart failure (HF) have not been well characterized.Methods Hospitalizations for AMI from the Nationwide Inpatient Sample (2015–2018) were categorized according to a preexisting diagnosis of HF with preserved ejection fraction (HFpEF), reduced ejection fraction (HFrEF), or absence of HF. Utilization of invasive management and in-hospital outcomes were analyzed.Results Among 2,434,639 hospitalizations with an AMI, 19.8% had a history of HFrEF and 11.9% had a history of HFpEF. Coronary angiography and PCI respectively were performed significantly less among patients with HF (36.6% and 17.4% in HFpEF, 51.1% and 24.6% in HFrEF, and 64.4% and 42.3% among patients without HF, all p < 0.0001). Mortality was more common among patients with HFrEF (10.3%) and HFpEF (8.3%) when compared to patients without a history of HF (6.4%), p < 0.0001. Conclusion HF is a common preexisting comorbidity among patients presenting with AMI and is associated with lower utilization of invasive procedures and higher complications including mortality, particularly among those with HFrEF.