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Heart failure in patients admitted for acute coronary syndromes: A report from a large national registry

Journal Paper/Review - Jun 9, 2017

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Citation
Jeger R, Pfister O, Radovanovic D, Eberli F, Rickli H, Urban P, Pedrazzini G, Stauffer J, Nossen J, Erne P, AMIS-Plus Investigators. Heart failure in patients admitted for acute coronary syndromes: A report from a large national registry. Clin Cardiol 2017; 40:907-913.
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Type
Journal Paper/Review (English)
Journal
Clin Cardiol 2017; 40
Publication Date
Jun 9, 2017
Issn Print
Issn Electronic
1932-8737
Pages
907-913
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Brief description/objective

BACKGROUND
Data on temporal trends of heart failure (HF) in acute coronary syndrome (ACS) are scarce.

HYPOTHESIS
Improved treatment options may have led to lower case-fatality rates (CFRs) during the last years in ACS complicated by HF.

METHODS
Patients of the nationwide Acute Myocardial Infarction in Switzerland (AMIS)-Plus ACS registry were analyzed from 2000 to 2014.

RESULTS
Of 36 366 ACS patients, 3376 (9.3%) had acute or chronic HF, 2111 (5.8%) de novo acute HF (AHF), 964 (2.7%) chronic HF (CHF), and 301 (0.8%) acute decompensated CHF (ADCHF). In-hospital CFRs were highest in patients with ADCHF (32.6%) and de novo AHF (29.7%), followed by patients with CHF (12.9%) and without HF (3.2%, P < 0.001). Although in-hospital CFRs gradually decreased in CHF patients (14.3% to 4.5%, P = 0.003) and patients without HF (3.5% to 2.2%, P < 0.001), they remained high in patients with ADCHF (36.4% to 40.0%, P = 0.45) and de novo AHF (50.0% to 29.4%, P = 0.37). Although there was an increase in specific ACS therapies in the cohort over time, ACS patients with HF received significantly less pharmacological and interventional ACS therapies than patients without HF. There was no significant change in HF medication rates except less frequent use of β-blockers and diuretics in de novo AHF patients in recent years.

CONCLUSIONS
HF is present in 1 out of 10 patients presenting with ACS and is associated with high in-hospital CFRs, particularly in acute HF. Although advances in ACS therapy improved in-hospital CFRs in patients with no HF or CHF, CFRs remained unchanged and high in patients with acute HF and ACS over the last decade.