Mode and risk indicators for death during 5 year follow-up of survivors of acute myocardial infarction. An evaluation with particular emphasis on congestive heart failure and age.

Abstract

To describe the mortality rate and the place and mode of death during a 5-year follow-up of patients admitted to hospital with congestive heart failure following an acute myocardial infarction (AMI). All the patients admitted to a single hospital following an AMI, regardless of age and whether or not they were admitted to a coronary care unit, were followed up prospectively for 5 years. A total of 882 AMI patients were included. The hospital mortality was 14%. Among patients who were discharged from hospital, the age range was 24-101 (median 70) years, 70% were men, 35% had experienced an anterior AMI and 31% had suffered an inferior AMI. Congestive heart failure was observed in 51% of the patients. Among patients discharged from hospital (n = 740), those with severe congestive heart failure had a mortality of 67% compared with 51% for those with moderate heart failure and 31% for those with no heart failure (P < 0.001). When simultaneously considering age, sex, history of cardiovascular disease, various complications in hospital and medication at discharge, the development of congestive heart failure was found to be an independent predictor of death. The mode and place of death after initial discharge from hospital was similar in patients with and in those without congestive heart failure. Among patients with congestive heart failure who were discharged from hospital, the following factors were associated with an increased risk of death: older age (P < 0.001), no prescription of beta-blockers at discharge (P < 0.01) and a previous history of infarction (P < 0.05). The prognosis during 5 years of follow-up after AMI was directly related to the severity of congestive heart failure based on a clinical assessment. The mode and place of death did not differ between patients with and without heart failure. Treatment with beta-blockers was associated with improved survival. Age had a major impact on the prognosis.