Management and outcomes following an acute coronary event in patients with chronic heart failure 1999–2007
Identifieur interne : 002543 ( Istex/Corpus ); précédent : 002542; suivant : 002544Management and outcomes following an acute coronary event in patients with chronic heart failure 1999–2007
Auteurs : Isuru Ranasinghe ; Chris Naoum ; Bernadette Aliprandi-Costa ; Andrew P. Sindone ; P. Gabriel Steg ; John Elliott ; Bruce Mcgarity ; Jeffrey Lefkovits ; David BriegerSource :
- European Journal of Heart Failure [ 1388-9842 ] ; 2012-05.
English descriptors
- KwdEn :
- Absolute decline, Absolute increase, Acute heart failure, Adverse events, Adverse outcomes, Angina, Arb, Aspirin, Astra zeneca, Baseline, Baseline characteristics, Baseline covariates, Blood pressure, Cabg, Cardiac, Cardiac arrest, Cardiac disease, Cardiac rehabilitation, Cardiac risk factors, Cerebrovascular attack, Chronic heart failure, Chronic heart failure table, Clinical practice, Coll cardiol, Concord repatriation, Congestive heart failure, Continuous variables, Coronary angiography, Coronary artery, Crude mortality, Discharge diagnosis, Diuretic, Echocardiography, Elderly patients, Enrolment, European society, Exercise training, Global registry, Glycoprotein inhibitors, Grace enrolment, Grace registry, Grace risk score, Heart failure, Heparin, High risk, Index admission, Infarction, Inhibitor, Ischaemic event, Killip class, Medical history, Medication, Molecular weight heparin, Month mortality, Month outcomes, Mortality, Mortality data, Myocardial, Myocardial infarction, Observational studies, Odds ratio, Performance measures, Presentation characteristics, Pulse serum creatinine, Readmission, Receptor blocker, Receptor blockers, Referral rates, Relative prevalence, Renal, Renal failure, Revascularization, Risk factors, Standard deviation, Statin, Stemi, Substantial increase, Syndrome, Systolic dysfunction, Systolic heart failure, Temporal, Temporal decline, Temporal improvement, Temporal increase, Temporal trend, Temporal trends, Thienopyridines, Time bias, Transient ischaemic attack, Unfractionated heparin, Unstable angina pectoris, Ventricular, Ventricular dysfunction, Ventricular ejection fraction, Year enrolment period, Year groups, Year period, Zealand population.
- Teeft :
- Absolute decline, Absolute increase, Acute heart failure, Adverse events, Adverse outcomes, Angina, Arb, Aspirin, Astra zeneca, Baseline, Baseline characteristics, Baseline covariates, Blood pressure, Cabg, Cardiac, Cardiac arrest, Cardiac disease, Cardiac rehabilitation, Cardiac risk factors, Cerebrovascular attack, Chronic heart failure, Chronic heart failure table, Clinical practice, Coll cardiol, Concord repatriation, Congestive heart failure, Continuous variables, Coronary angiography, Coronary artery, Crude mortality, Discharge diagnosis, Diuretic, Echocardiography, Elderly patients, Enrolment, European society, Exercise training, Global registry, Glycoprotein inhibitors, Grace enrolment, Grace registry, Grace risk score, Heart failure, Heparin, High risk, Index admission, Infarction, Inhibitor, Ischaemic event, Killip class, Medical history, Medication, Molecular weight heparin, Month mortality, Month outcomes, Mortality, Mortality data, Myocardial, Myocardial infarction, Observational studies, Odds ratio, Performance measures, Presentation characteristics, Pulse serum creatinine, Readmission, Receptor blocker, Receptor blockers, Referral rates, Relative prevalence, Renal, Renal failure, Revascularization, Risk factors, Standard deviation, Statin, Stemi, Substantial increase, Syndrome, Systolic dysfunction, Systolic heart failure, Temporal, Temporal decline, Temporal improvement, Temporal increase, Temporal trend, Temporal trends, Thienopyridines, Time bias, Transient ischaemic attack, Unfractionated heparin, Unstable angina pectoris, Ventricular, Ventricular dysfunction, Ventricular ejection fraction, Year enrolment period, Year groups, Year period, Zealand population.
Abstract
The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time.
Url:
DOI: 10.1093/eurjhf/hfs041
Links to Exploration step
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<author><name sortKey="Naoum, Chris" sort="Naoum, Chris" uniqKey="Naoum C" first="Chris" last="Naoum">Chris Naoum</name>
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<author><name sortKey="Aliprandi Osta, Bernadette" sort="Aliprandi Osta, Bernadette" uniqKey="Aliprandi Osta B" first="Bernadette" last="Aliprandi-Costa">Bernadette Aliprandi-Costa</name>
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<author><name sortKey="Steg, P Gabriel" sort="Steg, P Gabriel" uniqKey="Steg P" first="P. Gabriel" last="Steg">P. Gabriel Steg</name>
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<affiliation><mods:affiliation>E-mail: davidb@email.cs.nsw.gov.au</mods:affiliation>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Absolute decline</term>
<term>Absolute increase</term>
<term>Acute heart failure</term>
<term>Adverse events</term>
<term>Adverse outcomes</term>
<term>Angina</term>
<term>Arb</term>
<term>Aspirin</term>
<term>Astra zeneca</term>
<term>Baseline</term>
<term>Baseline characteristics</term>
<term>Baseline covariates</term>
<term>Blood pressure</term>
<term>Cabg</term>
<term>Cardiac</term>
<term>Cardiac arrest</term>
<term>Cardiac disease</term>
<term>Cardiac rehabilitation</term>
<term>Cardiac risk factors</term>
<term>Cerebrovascular attack</term>
<term>Chronic heart failure</term>
<term>Chronic heart failure table</term>
<term>Clinical practice</term>
<term>Coll cardiol</term>
<term>Concord repatriation</term>
<term>Congestive heart failure</term>
<term>Continuous variables</term>
<term>Coronary angiography</term>
<term>Coronary artery</term>
<term>Crude mortality</term>
<term>Discharge diagnosis</term>
<term>Diuretic</term>
<term>Echocardiography</term>
<term>Elderly patients</term>
<term>Enrolment</term>
<term>European society</term>
<term>Exercise training</term>
<term>Global registry</term>
<term>Glycoprotein inhibitors</term>
<term>Grace enrolment</term>
<term>Grace registry</term>
<term>Grace risk score</term>
<term>Heart failure</term>
<term>Heparin</term>
<term>High risk</term>
<term>Index admission</term>
<term>Infarction</term>
<term>Inhibitor</term>
<term>Ischaemic event</term>
<term>Killip class</term>
<term>Medical history</term>
<term>Medication</term>
<term>Molecular weight heparin</term>
<term>Month mortality</term>
<term>Month outcomes</term>
<term>Mortality</term>
<term>Mortality data</term>
<term>Myocardial</term>
<term>Myocardial infarction</term>
<term>Observational studies</term>
<term>Odds ratio</term>
<term>Performance measures</term>
<term>Presentation characteristics</term>
<term>Pulse serum creatinine</term>
<term>Readmission</term>
<term>Receptor blocker</term>
<term>Receptor blockers</term>
<term>Referral rates</term>
<term>Relative prevalence</term>
<term>Renal</term>
<term>Renal failure</term>
<term>Revascularization</term>
<term>Risk factors</term>
<term>Standard deviation</term>
<term>Statin</term>
<term>Stemi</term>
<term>Substantial increase</term>
<term>Syndrome</term>
<term>Systolic dysfunction</term>
<term>Systolic heart failure</term>
<term>Temporal</term>
<term>Temporal decline</term>
<term>Temporal improvement</term>
<term>Temporal increase</term>
<term>Temporal trend</term>
<term>Temporal trends</term>
<term>Thienopyridines</term>
<term>Time bias</term>
<term>Transient ischaemic attack</term>
<term>Unfractionated heparin</term>
<term>Unstable angina pectoris</term>
<term>Ventricular</term>
<term>Ventricular dysfunction</term>
<term>Ventricular ejection fraction</term>
<term>Year enrolment period</term>
<term>Year groups</term>
<term>Year period</term>
<term>Zealand population</term>
</keywords>
<keywords scheme="Teeft" xml:lang="en"><term>Absolute decline</term>
<term>Absolute increase</term>
<term>Acute heart failure</term>
<term>Adverse events</term>
<term>Adverse outcomes</term>
<term>Angina</term>
<term>Arb</term>
<term>Aspirin</term>
<term>Astra zeneca</term>
<term>Baseline</term>
<term>Baseline characteristics</term>
<term>Baseline covariates</term>
<term>Blood pressure</term>
<term>Cabg</term>
<term>Cardiac</term>
<term>Cardiac arrest</term>
<term>Cardiac disease</term>
<term>Cardiac rehabilitation</term>
<term>Cardiac risk factors</term>
<term>Cerebrovascular attack</term>
<term>Chronic heart failure</term>
<term>Chronic heart failure table</term>
<term>Clinical practice</term>
<term>Coll cardiol</term>
<term>Concord repatriation</term>
<term>Congestive heart failure</term>
<term>Continuous variables</term>
<term>Coronary angiography</term>
<term>Coronary artery</term>
<term>Crude mortality</term>
<term>Discharge diagnosis</term>
<term>Diuretic</term>
<term>Echocardiography</term>
<term>Elderly patients</term>
<term>Enrolment</term>
<term>European society</term>
<term>Exercise training</term>
<term>Global registry</term>
<term>Glycoprotein inhibitors</term>
<term>Grace enrolment</term>
<term>Grace registry</term>
<term>Grace risk score</term>
<term>Heart failure</term>
<term>Heparin</term>
<term>High risk</term>
<term>Index admission</term>
<term>Infarction</term>
<term>Inhibitor</term>
<term>Ischaemic event</term>
<term>Killip class</term>
<term>Medical history</term>
<term>Medication</term>
<term>Molecular weight heparin</term>
<term>Month mortality</term>
<term>Month outcomes</term>
<term>Mortality</term>
<term>Mortality data</term>
<term>Myocardial</term>
<term>Myocardial infarction</term>
<term>Observational studies</term>
<term>Odds ratio</term>
<term>Performance measures</term>
<term>Presentation characteristics</term>
<term>Pulse serum creatinine</term>
<term>Readmission</term>
<term>Receptor blocker</term>
<term>Receptor blockers</term>
<term>Referral rates</term>
<term>Relative prevalence</term>
<term>Renal</term>
<term>Renal failure</term>
<term>Revascularization</term>
<term>Risk factors</term>
<term>Standard deviation</term>
<term>Statin</term>
<term>Stemi</term>
<term>Substantial increase</term>
<term>Syndrome</term>
<term>Systolic dysfunction</term>
<term>Systolic heart failure</term>
<term>Temporal</term>
<term>Temporal decline</term>
<term>Temporal improvement</term>
<term>Temporal increase</term>
<term>Temporal trend</term>
<term>Temporal trends</term>
<term>Thienopyridines</term>
<term>Time bias</term>
<term>Transient ischaemic attack</term>
<term>Unfractionated heparin</term>
<term>Unstable angina pectoris</term>
<term>Ventricular</term>
<term>Ventricular dysfunction</term>
<term>Ventricular ejection fraction</term>
<term>Year enrolment period</term>
<term>Year groups</term>
<term>Year period</term>
<term>Zealand population</term>
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<front><div type="abstract">The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time.</div>
</front>
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<author><json:item><name>Isuru Ranasinghe</name>
<affiliations><json:string>Concord Repatriation General Hospital and The University of Sydney, NSW, Sydney, Australia</json:string>
</affiliations>
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<json:item><name>Chris Naoum</name>
<affiliations><json:string>Concord Repatriation General Hospital and The University of Sydney, NSW, Sydney, Australia</json:string>
</affiliations>
</json:item>
<json:item><name>Bernadette Aliprandi‐Costa</name>
<affiliations><json:string>Concord Repatriation General Hospital and The University of Sydney, NSW, Sydney, Australia</json:string>
</affiliations>
</json:item>
<json:item><name>Andrew P. Sindone</name>
<affiliations><json:string>Concord Repatriation General Hospital and The University of Sydney, NSW, Sydney, Australia</json:string>
</affiliations>
</json:item>
<json:item><name>P. Gabriel Steg</name>
<affiliations><json:string>INSERM U‐698, Hôpital Bichat, and Universite Paris 7, Paris, France</json:string>
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</json:item>
<json:item><name>John Elliott</name>
<affiliations><json:string>Christchurch Hospital, Christchurch, New Zealand</json:string>
</affiliations>
</json:item>
<json:item><name>Bruce McGarity</name>
<affiliations><json:string>Bathurst Base Hospital, NSW, Bathurst, Australia</json:string>
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</json:item>
<json:item><name>Jeffrey Lefkovits</name>
<affiliations><json:string>Royal Melbourne Hospital, Victoria, Melbourne, Australia</json:string>
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<json:item><name>David Brieger</name>
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<json:string>E-mail: davidb@email.cs.nsw.gov.au</json:string>
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<subject><json:item><lang><json:string>eng</json:string>
</lang>
<value>acute coronary syndromes</value>
</json:item>
<json:item><lang><json:string>eng</json:string>
</lang>
<value>heart failure</value>
</json:item>
<json:item><lang><json:string>eng</json:string>
</lang>
<value>epidemiology</value>
</json:item>
<json:item><lang><json:string>eng</json:string>
</lang>
<value>outcomes research</value>
</json:item>
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Aim
<p>The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time.</p>
Method and results
<p>A total of 5556 patients enrolled in the Australia–New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included. Patients with CHF (<hi rend="italic">n</hi>
= 609) were compared with those without CHF (<hi rend="italic">n</hi>
= 4947). Patients with CHF were on average 10 years older, were more likely to be female, had more co‐morbidities and cardiac risk factors, and were more likely to have a prior history of angina, myocardial infarction, and revascularization by coronary artery bypass graft (CABG) when compared with those without CHF. CHF was associated with a substantial increase in in‐hospital renal failure [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.15–2.71], readmission post‐discharge (OR 1.47, 95% CI 1.17–1.90), and 6‐month mortality (OR 2.25, 95% CI 1.55–3.27). Over the 9 year study period, in‐hospital and 6 month mortality in those with CHF declined by absolute rates of 7.5% and 14%, respectively. This was temporally associated with an increase in prescription of thienopyridines, beta‐blockers, statins, and angiotensin II receptor blockers, increased rates of coronary angiography, and 31.8% absolute increase in referral rates for cardiac rehabilitation.</p>
Conclusions
<p>Acute coronary syndrome patients with pre‐existing CHF are a very high risk group and carry a disproportionate mortality burden. Encouragingly, there was a marked temporal improvement in outcomes over a 9 year period with an increase in evidence‐based treatments and secondary preventative measures.</p>
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<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">John</namePart>
<namePart type="family">Elliott</namePart>
<affiliation>Christchurch Hospital, Christchurch, New Zealand</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Bruce</namePart>
<namePart type="family">McGarity</namePart>
<affiliation>Bathurst Base Hospital, NSW, Bathurst, Australia</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Jeffrey</namePart>
<namePart type="family">Lefkovits</namePart>
<affiliation>Royal Melbourne Hospital, Victoria, Melbourne, Australia</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">David</namePart>
<namePart type="family">Brieger</namePart>
<affiliation>Concord Repatriation General Hospital and The University of Sydney, NSW, Sydney, Australia</affiliation>
<affiliation>E-mail: davidb@email.cs.nsw.gov.au</affiliation>
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<name type="corporate"><namePart>on behalf of the Australia–New Zealand GRACE</namePart>
</name>
<typeOfResource>text</typeOfResource>
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<originInfo><publisher>Blackwell Publishing Ltd</publisher>
<dateIssued encoding="w3cdtf">2012-05</dateIssued>
<dateCreated encoding="w3cdtf">2014-02-06</dateCreated>
<dateCaptured encoding="w3cdtf">2011-12-28</dateCaptured>
<dateValid encoding="w3cdtf">2012-03-02</dateValid>
<copyrightDate encoding="w3cdtf">2012</copyrightDate>
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<language><languageTerm type="code" authority="rfc3066">en</languageTerm>
<languageTerm type="code" authority="iso639-2b">eng</languageTerm>
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<abstract>The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time.</abstract>
<abstract>A total of 5556 patients enrolled in the Australia–New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included. Patients with CHF (n = 609) were compared with those without CHF (n = 4947). Patients with CHF were on average 10 years older, were more likely to be female, had more co‐morbidities and cardiac risk factors, and were more likely to have a prior history of angina, myocardial infarction, and revascularization by coronary artery bypass graft (CABG) when compared with those without CHF. CHF was associated with a substantial increase in in‐hospital renal failure [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.15–2.71], readmission post‐discharge (OR 1.47, 95% CI 1.17–1.90), and 6‐month mortality (OR 2.25, 95% CI 1.55–3.27). Over the 9 year study period, in‐hospital and 6 month mortality in those with CHF declined by absolute rates of 7.5% and 14%, respectively. This was temporally associated with an increase in prescription of thienopyridines, beta‐blockers, statins, and angiotensin II receptor blockers, increased rates of coronary angiography, and 31.8% absolute increase in referral rates for cardiac rehabilitation.</abstract>
<abstract>Acute coronary syndrome patients with pre‐existing CHF are a very high risk group and carry a disproportionate mortality burden. Encouragingly, there was a marked temporal improvement in outcomes over a 9 year period with an increase in evidence‐based treatments and secondary preventative measures.</abstract>
<subject><genre>keywords</genre>
<topic>acute coronary syndromes</topic>
<topic>heart failure</topic>
<topic>epidemiology</topic>
<topic>outcomes research</topic>
</subject>
<relatedItem type="host"><titleInfo><title>European Journal of Heart Failure</title>
</titleInfo>
<titleInfo type="abbreviated"><title>European Journal of Heart Failure</title>
</titleInfo>
<genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre>
<subject><genre>article-category</genre>
<topic>Epidemiology</topic>
</subject>
<identifier type="ISSN">1388-9842</identifier>
<identifier type="eISSN">1879-0844</identifier>
<identifier type="DOI">10.1002/(ISSN)1879-0844</identifier>
<identifier type="PublisherID">EJHF</identifier>
<part><date>2012</date>
<detail type="volume"><caption>vol.</caption>
<number>14</number>
</detail>
<detail type="issue"><caption>no.</caption>
<number>5</number>
</detail>
<extent unit="pages"><start>464</start>
<end>472</end>
<total>9</total>
</extent>
</part>
</relatedItem>
<identifier type="istex">C90654708B94AECAB04DD423F7766C284F587338</identifier>
<identifier type="ark">ark:/67375/WNG-HXPCHNCJ-B</identifier>
<identifier type="DOI">10.1093/eurjhf/hfs041</identifier>
<identifier type="ArticleID">EJHFHFS041</identifier>
<accessCondition type="use and reproduction" contentType="copyright">© 2012 European Society of CardiologyPublished on behalf of the European Society of Cardiology. All rights reserved. © 2012 the Authors</accessCondition>
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