Acute heart failure with and without acute coronary syndrome: clinical correlates and prognostic impact (From the HEARTS registry)

Abstract

BackgroundLittle is know about the outcomes of acute heart failure (AHF) with acute coronary syndrome (ACS-AHF), compared to those without ACS (NACS-AHF).MethodsWe conducted a prospective registry of AHF patients involving 18 hospitals in Saudi Arabia between October 2009 and December 2010. In this sub-study, we compared the clinical correlates, management and hospital course, as well as short, and long-term outcomes between AHF patients with and without ACS.ResultsOf the 2609 AHF patients enrolled, 27.8 % presented with ACS. Compared to NACS-AHF patients, ACS-AHF patients were more likely to be old males (Mean age = 62.7 vs. 60.8 years, p = 0.003, and 73.8 % vs. 62.7 %, p < 0.001, respectively), and to present with De-novo heart failure (56.6 % vs. 28.1 %, p < 0.001). Additionally they were more likely to have history of ischemic heart disease, diabetes, dyslipidemia, and less likely to have chronic kidney disease (p < 0.001 for all comparisons). The prevalence of severe LV systolic dysfunction (EF < 30 %) was higher in ACS-AHF patients. During hospital stay, ACS-AHF patients were more likely to develop shock (p < 0.001), recurrent heart failure (p = 0.02) and needed more mechanical ventilation (p < 0.001). β blockers and Angiotensin Converting Enzyme inhibitors were used more often in ACS-AHF patients (p = 0.001 and, p = 0.004 respectively). ACS- AHF patients underwent more coronary angiography and had higher prevalence of multi-vessel coronary artery disease (p < 0.001 for all comparisons). The unadjusted hospital and one-month mortality were higher in ACS-AHF patients (OR = 1.6 (1.2–2.2), p = 0.003 and 1.4 (1.0–1.9), p = 0.026 respectively). A significant interaction existed between the level of left ventricular ejection fraction and ACS-AHF status. After adjustment, ACS-AHF status was only significantly associated with hospital mortality (OR = 1.6 (1.1–2.4), p = 0.019). The three-years survival following hospital discharge was not different between the two groups.ConclusionAHF patients presenting with ACS had worse hospital prognosis, and an equivalent long-term survival compared to AHF patients without ACS. These findings underscore the importance of timely recognition and management of AHF patients with concomitant ACS given their distinct presentation and underlying pathophysiology compared to other AHF patients.

Precipitating factors and 90‐day outcome of acute heart failure: a report from the intercontinental GREAT registry

“…In our large cohort, ACS was shown to be the most common precipitant of AHF, as previously shown in the OPTIMIZE‐HF and in the French EFICA (Etude Française de l'Insuffisance Cardiaque Aiguë) registries . Previous data showed that ACS complicated by AHF carries a particularly high risk of adverse outcome and, similarly, AHF caused by ACS is associated with the highest risk of short‐term death, as confirmed by our study . The unfavourable association between AHF and (ischaemic) myocardial injury is further supported by the analyses of the ADHERE (Acute Decompensated Heart Failure National Registry) study, which reported a marked association between elevated cardiac troponin levels and increased risk of death in AHF .…”

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

“…The present analysis of over 36 000 patients admitted to acute cardiac care hospitals in Switzerland corroborates these findings by showing high in‐hospital morbidity and mortality rates in patients presenting in a real‐world population with both ACS and HF. In line with other registries, almost two‐thirds of patients with ACS and HF presented with de novo AHF . According to the EuroHeart Failure Survey II, ACS is the predominant cause of de novo AHF, contributing to 42% of de novo AHF .…”

“…In line with other registries, almost two-thirds of patients with ACS and HF presented with de novo AHF. 26,27 According to the EuroHeart Failure Survey II, ACS is the predominant cause of de novo AHF, contributing to 42% of de novo AHF. 28 Specifically, in the case of large myocardial infarction, extensive ischemia with myocardial stunning or the presence of ischemic mitral regurgitation, ACS may be a trigger of de novo AHF or ADCHF.…”

Scared for the scar: fearsome impact of acute cardiovascular disease on perceived kinesiophobia (fear of movement)

“…Up to one‐third of patients with AHF present with ACS. Compared to non–ACS‐AHF patients, ACS‐AHF patients are more likely to be older males; present with de novo HF; have severe left ventricular systolic dysfunction; have multivessel coronary artery disease; have a history of ischemic heart disease, diabetes, dyslipidemia; and are less likely to have chronic kidney disease . During a hospital stay, ACS‐AHF patients are more likely to develop shock and recurrent HF, need more mechanical ventilation, and receive β‐blockers and angiotensin‐converting enzyme inhibitors, and in‐hospital mortality is significantly higher.…”

“…have a history of ischemic heart disease, diabetes, dyslipidemia; and are less likely to have chronic kidney disease. 13 During a hospital stay, ACS-AHF patients are more likely to develop shock and recurrent HF, need more mechanical ventilation, and receive β-blockers and angiotensin-converting enzyme inhibitors, and in-hospital mortality is significantly higher. Whereas medical history and the manifestation and initial treatment of AHF between ACS-AHF and non-ACS-AHF patients differ, long-term survival is similar.…”