Temporal Trends in Outcomes of ST-Elevation Myocardial Infarction Patients With Heart Failure and Diabetes

Bassem Ali,Charbel Abi Khalil,Hani Jneid,Jassim Al Suwaidi,Soha Dargham

doi:10.3389/fphys.2022.803092

Abstract

AimsWe aimed to assess temporal trends in outcomes of ST-elevation myocardial infarction (STEMI) patients with diabetes and heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) and compared both groups.MethodsData from the National Inpatient Sample was analyzed between 2005 and 2017. We assessed hospitalizations rate and in-hospital mortality, ventricular tachycardia (VT), ventricular fibrillation (VF), atrial fibrillation (AF), cardiogenic shock (CS), ischemic stroke, acute renal failure (ARF), and revascularization strategy. Socio-economic outcomes consisted of the length of stay (LoS) and total charges/stay.ResultsHospitalization rate steadily decreased with time in STEMI patients with diabetes and HFrEF. Mean age (SD) decreased from 71 ± 12 to 67 ± 12 (p < 0.01), while the prevalence of comorbidities increased. Mortality was stable (around 9%). However, VT, VF, AF, CS, ischemic stroke, and ARF significantly increased with time. In STEMI patients with HFpEF and diabetes, the hospitalization rate significantly increased with time while mean age was stable. The prevalence of comorbidities increased, mortality remained stable (around 4%), but VF, ischemic stroke, and ARF increased with time. Compared to patients with HFrEF, HFpEF patients were 2 years older, more likely to be females, suffered from more cardio-metabolic risk factors, and had a higher prevalence of cardiovascular diseases. However, HFpEF patients were less likely to die [adjusted OR = 0.635 (0.601-0.670)] or develop VT [adjusted OR = 0.749 (0.703-0.797)], VF [adjusted OR = 0.866 (0.798-0.940)], ischemic stroke [adjusted OR = 0.871 [0.776-0.977)], and CS [adjusted OR = 0.549 (0.522-0.577)], but more likely to develop AF [adjusted OR = 1.121 (1.078-1.166)]. HFpEF patients were more likely to get PCI but less likely to get thrombolysis or CABG. Total charges per stay increased by at least 2-fold in both groups. There was a slight temporal reduction over the study period in the LoS of the HFpEF.ConclusionWhile hospitalizations for STEMI in patients with diabetes and HFpEF followed an upward trend, we observed a temporal decrease in those with HFrEF. Mortality was unchanged in both HF groups despite the temporal increase in risk factors. Nevertheless, HFpEF patients had lower in-hospital mortality and cardiovascular events, except for AF.

Highlights

Heart failure (HF) has been described as a growing pandemic with a significant economic burden
Ventricular fibrillation, ventricular tachycardia, atrial fibrillation, ischemic stroke, and acute renal failure increased with time (p < 0.001 for all)
To the best of our knowledge, we report in this analysis that most cases of patients with ST-elevation myocardial infarction (STEMI) with diabetes with preexisting heart failure are HFrEF

Summary

Introduction

Heart failure (HF) has been described as a growing pandemic with a significant economic burden. HF is associated with increased morbidity and mortality, especially in the elderly, who are subject to frequent rehospitalizations (Thrainsdottir et al, 2005; Roth et al, 2015). In a study that examined the association between HF and mortality in patients discharged after their first MI, the 1-year mortality rate was 13.9% in patients with HF compared to 2.4% in patients with no HF (Dunlay et al, 2019). Another study found that up to 10% of patients presenting with the acute coronary syndrome (ACS) have underlying heart failure, which predisposed them to higher in-hospital mortality (Jeger et al, 2017)

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