Desta et al identified factors associated with the late-onset of heart failure following an acute myocardial infarction (AMI). These can help to identify a patient who may benefit from more aggressive management. The authors are from Danderyd University Hospital, Karolinska Institutet and Karolinska University Hospital in Stockholm.
Patient selection: acute myocardial infarction (AMI) in a patient without history of heart failure
Patients were divided into 4 groups based on combinations of heart failure and ejection fraction (no heart failure and normal LVEF, no heart failure and reduced LVEF, heart failure and normal LVEF, heart failure and reduced LVEF).
Late-onset heart failure was defined as rehospitalization with heart failure given as principal or secondary diagnosis (time interval not specified).
Predictors of late-onset heart failure:
(1) heart failure in the hospital for management of the acute heart failure (? early onset HF)
(2) increasing age (from Table 1, mean age for no late-onset heart failure was around 68 years, versus 78 years for late-onset group. Will use >= 70 as measure in the implementation).
(3) increasing number of comorbid conditions
Comorbid conditions:
(1) diabetes mellitus
(2) chronic kidney disease
(3) chronic obstructive pulmonary disease (COPD)
(4) peripheral arterial disease (PAD)
(5) atrial fibrillation
(6) coronary artery disease (as past history of myocardial infarction)
(7) cerebrovascular disease (as past history of stroke)
The authors noted a lower risk of late-onset heart failure over time. This change may be related to more aggressive management of the AMI (revascularization, etc) and better control of comorbidities.
