National Trends in the Incidence, Management, and Outcomes of Heart Failure Complications in Patients Hospitalized for ST-Segment Elevation Myocardial Infarction

Manyoo Agarwal; Sahil Agrawal; Lohit Garg; Divyanshu Mohananey; Aakash Garg; Nirmanmoh Bhatia; Carl J Lavie

doi:10.1016/j.mayocpiqo.2017.05.004

National Trends in the Incidence, Management, and Outcomes of Heart Failure Complications in Patients Hospitalized for ST-Segment Elevation Myocardial Infarction

Mayo Clin Proc Innov Qual Outcomes. 2017 Jun 8;1(1):26-36. doi: 10.1016/j.mayocpiqo.2017.05.004. eCollection 2017 Jul.

Authors

Manyoo Agarwal¹, Sahil Agrawal², Lohit Garg³, Divyanshu Mohananey⁴, Aakash Garg⁵, Nirmanmoh Bhatia⁶, Carl J Lavie⁷

Affiliations

¹ Department of Internal Medicine, University of Tennessee Health Science Center, Memphis.
² Division of Cardiovascular Medicine, Department of Internal Medicine, St Luke's University Health Network, Bethlehem, PA.
³ Division of Cardiovascular Medicine, Department of Internal Medicine, Lehigh Valley Network Hospital, Allentown, PA.
⁴ Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
⁵ Department of Internal Medicine, Saint Peter's Health, New Brunswick, NJ.
⁶ Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt Medical Center, Nashville, TN.
⁷ Department of Cardiovascular Medicine, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.

Abstract

Objective: To analyze contemporary trends in the incidence, management, and clinical outcomes of heart failure (HF) complications in patients hospitalized for ST-segment elevation myocardial infarction (STEMI) in the United States.

Patients and methods: Using the 2003 through 2010 Nationwide Inpatient Sample databases, all patients with STEMI who were 18 years and older with acute HF were identified. Overall trends in the incidence of HF, coronary intervention, and in-hospital mortality were analyzed.

Results: Of 1,990,002 hospitalizations with a primary diagnosis of STEMI, 471,525 (23.7%) had HF complication (decreasing from 25.4% [95% CI, 25.3%-25.6%] in 2003 to 20.7% [95% CI, 20.5%-20.8%]) in 2010 (P trend<.001). The incidence of cardiogenic shock in patients with HF-complicated STEMI increased from 13.9% (95% CI, 13.6%-14.1%) to 22.6% (95% CI, 22.2%-23.0%) during this period (P trend<.001). From 2003 through 2010, the use of diagnostic coronary angiography and percutaneous coronary intervention increased in patients with HF-complicated STEMI from 44.3% to 62.1% and from 25.0% to 48.1%, respectively. In-hospital mortality decreased significantly in patients with HF-complicated STEMI (from 18.1% to 15.1%) and in subgroups of those with (from 42.4% to 29.9%) and without (from 14.1% to 10.8%) cardiogenic shock (all P trend<.001). The adjusted odds ratio (AOR) (per year) of death was 0.992 (95% CI, 0.988-0.997; P<.001), which changed significantly after additional adjustment for coronary intervention (AOR [per year], 1.012; 95% CI, 1.008-1.017; P<.001).

Conclusion: The incidence and in-hospital mortality of HF-complicated STEMI has decreased significantly during recent times along with increased use of percutaneous coronary intervention and diagnostic coronary angiography.

Keywords: ACE, angiotensin-converting enzyme; AMI, acute myocardial infarction; AOR, adjusted odds ratio; CABG, coronary artery bypass graft; CPI, consumer price index; CV, cardiovascular; HF, heart failure; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; IQR, interquartile range; LOS, length of stay; NIS, Nationwide Inpatient Sample; NRMI-2, National Registry of Myocardial Infarction-2; OR, odds ratio; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; UOR, unadjusted odds ratio; dCA, diagnostic coronary angiography.