Why the study?
While secondary prevention post-ACS has traditionally focused on recurrent ischaemic events and short-term mortality, the long-term development of incident heart failure remains underexplored, with existing evidence limited to outdated or small-scale studies.
Cohort (n=83,357)
Yes
Nearly one in four acute coronary syndrome survivors develop new-onset heart failure over long-term follow-up, which is associated with markedly higher mortality (48.8% vs 13.5%), MACE (71.3% vs 33.2%), and a nearly tripled first-year healthcare cost.
Answers are grounded in this paper and cite their sources.
Post-ACS HF incidence signals need for vigilant surveillance; leaves open whether targeted prevention improves long-term outcomes.
Background The cardiovascular disease continuum encompasses a progressive trajectory from risk factors to coronary artery disease, heart failure (HF), and end-stage cardiac dysfunction. Acute coronary syndromes (ACS)—including STEMI, NSTEMI, and unstable angina—are pivotal events in this progression. While secondary prevention post-ACS has traditionally focused on reducing recurrent ischaemic events and short-term mortality, the long-term development of incident heart failure (iHF) remains underexplored. Existing evidence is limited and often derived from outdated or small-scale studies. This study aimed to characterise the real-world incidence, risk factors, clinical outcomes, and healthcare burden of iHF following ACS in a large, population-based cohort. Methods We conducted a retrospective cohort study using data from the Catalan Health Surveillance System, encompassing all residents discharged alive after an ACS event between 2011 and 2021 in Catalonia (7,763,362 inhabitants), Spain. Patients with prior HF or in-hospital mortality were excluded. iHF was defined as the first post-discharge HF diagnosis in hospital or primary care (with concurrent loop diuretic prescription). Multivariable competing risk regression models (Fine and Gray) were used to identify predictors of iHF. Time-to-event analyses assessed major adverse cardiovascular events (MACE), and generalised linear models evaluated healthcare resource use and costs. Results Among 83,357 patients (mean age 66.8 years; 71.4% male), 23.3% developed iHF during follow-up. The 10-year cumulative incidence of HF was 33% (95% CI: 33–34%). Key predictors of iHF included older age (HR=1.03 per year), Killip class II–III (HR=2.16), and very low income (HR=2.08), while PCI during index ACS was protective (HR=0.72). Patients with iHF (Table 1) experienced significantly higher rates of all-cause death (48.8% vs 13.5%), recurrent ACS, stroke, atrial fibrillation, and MACE (71.3% vs 33.2%). Healthcare costs (Figure 1) rose sharply post-ACS, particularly among iHF patients, whose first-year costs nearly tripled compared to pre-ACS levels. iHF independently predicted increased use of primary care (IRR=1.63), unplanned hospitalisations (IRR=5.56), pharmacological treatments (IRR=1.97), and long-term care services (IRR=8.19), with a significant rise in overall healthcare expenditure (β=0.73). Conclusions In this large, real-world cohort, nearly one in four ACS survivors developed iHF, which was associated with markedly worse clinical outcomes and a substantial healthcare burden. Older age, ACS severity, and socioeconomic deprivation were key risk factors, while PCI was protective. These findings highlight the need for early risk stratification, targeted preventive strategies, and healthcare system planning to address the long-term impact of iHF in post-ACS populations.
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COMINCOLET et al. (2026) conducted a cohort in Acute coronary syndromes (n=83,357). New-onset incident heart failure post-ACS vs. Patients without incident heart failure post-ACS was evaluated on Major adverse cardiovascular events (MACE).
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