Impact of a 'stent for life' initiative on post-ST elevation myocardial infarction heart failure: a 15year heart failure clinic experience.

Abstract

AimsMultidisciplinary heart failure (HF) clinics are a cornerstone of contemporary HF management. The stent‐for‐life (SFL) initiative improves mortality after ST elevation myocardial infarction (STEMI), but its impact in post‐STEMI HF is not well characterized. Here we assessed the impact of SFL among patients referred to a multidisciplinary HF clinic over a 15 year time period.Methods and resultsBetween 2001 and 2015, 1921 patients were admitted to our HF clinic. In 2009, Catalonia established the Codi IAM network, a regional STEMI network that prioritizes primary percutaneous coronary intervention in STEMI. Patients admitted during the study period were divided into two groups based on admission date: pre‐SFL (2001–June 2009; n = 1031) and post‐SFL (July 2009–2015; n = 890). Compared with those in the pre‐SFL group, patients admitted in the post‐SFL period had better New York Heart Association (NYHA) functional class (22.1 vs. 38.7 NYHA classes III–IV; P < 0.001) and higher left ventricular ejection fraction (LVEF) (36.1 ± 19.6 vs. 32.6 ± 13.4; P < 0.001). Among STEMI survivors, 101 (6.7%) pre‐SFL patients and 40 (2%) post‐SFL patients (P < 0.001) fulfilled the criteria for HF clinic referral (Killip–Kimball class ≥ 2 during index admission and/or LVEF of <40%). Furthermore, among patients admitted to the HF clinic, post‐STEMI HF with reduced ejection fraction patients comprised 8.9% of the pre‐SFL group and only 4.2% of the post‐SFL group (P < 0.001).ConclusionsAmong patients treated at our multidisciplinary HF clinic, the adoption of an SFL network has decreased the prevalence of post‐STEMI HF with reduced ejection fraction.