Objectives To investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of patients with MI using routinely collected primary and hospital care electronic health records (EHRs). Methods Data were used from the CALIBER programme, linking EHRs in England from primary care, hospital admissions, an MI registry and mortality data. Subjects were eligible if they were 18 years or older, did not have a history of HF and survived a first MI. Factors associated with time to HF were examined using Cox proportional hazard models. Results Of the 24 479 patients with MI, 5775 (23.6%) developed HF during a median follow-up of 3.7 years (incidence rate per 1000 person-years: 63.8, 95% CI 62.2 to 65.5). Baseline characteristics significantly associated with developing HF were: atrial fibrillation (HR 1.62, 95% CI 1.51 to 1.75), age (per 10 years increase: 1.45, 1.41 to 1.49), diabetes (1.45, 1.35 to 1.56), peripheral arterial disease (1.38, 1.26 to 1.51), chronic obstructive pulmonary disease (1.28, 1.17 to 1.40), greater socioeconomic deprivation (5th vs 1st quintile: 1.27, 1.13 to 1.41), ST-segment elevation MI at presentation (1.19, 1.11 to 1.27) and hypertension (1.16, 1.09 to 1.23). Results were robust to various sensitivity analyses such as competing risk analysis and multiple imputation. Conclusion In England, one in four survivors of a first MI develop HF within 4 years. This contemporary study demonstrates that patients with MI are at considerable risk of HF. Baseline patient characteristics associated with time until HF were identified, which may be used to target preventive strategies.
An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors
J. Gho,A. Schmidt,L. Pasea,S. Koudstaal,M. Pujades-Rodriguez,Spiros C. Denaxas,A. Shah,R. Patel,C. Gale,A. Hoes,J. Cleland,H. Hemingway,F. Asselbergs
Published 2018 in BMJ Open
ABSTRACT
PUBLICATION RECORD
- Publication year
2018
- Venue
BMJ Open
- Publication date
2018-03-01
- Fields of study
Medicine
- Identifiers
- External record
- Source metadata
Semantic Scholar, PubMed
CITATION MAP
EXTRACTION MAP
CLAIMS
CONCEPTS
- atrial fibrillation
A common cardiac arrhythmia recorded as a baseline patient characteristic in the cohort.
Aliases: AF
- caliber programme
An England-based data-linkage research resource combining primary care, hospital admissions, registry, and mortality records.
- cox proportional hazard models
A survival-analysis method used to estimate associations with time until heart failure.
Aliases: Cox models
- diabetes
A chronic metabolic disease recorded as a baseline patient characteristic in the cohort.
- electronic health records
Routinely collected linked clinical records used here as the study data source.
Aliases: EHRs
- heart failure
A clinical syndrome of impaired cardiac function that was measured as the post-myocardial-infarction outcome.
Aliases: HF
- myocardial infarction
An acute ischemic event in which blood flow to part of the heart is blocked, serving as the index diagnosis for cohort entry.
Aliases: MI
- st-segment elevation myocardial infarction
A myocardial infarction subtype identified at presentation as one of the baseline clinical characteristics.
Aliases: STEMI
REFERENCES
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