HF-related Mortality Research Articles

Evolving therapies for the management of chronic and acute decompensated heart failure.

The pharmacology, clinical efficacy, and safety profiles of evolving therapies for the management of chronic heart failure (HF) and acute decompensated heart failure (ADHF) are described. HF confers a significant financial burden despite the widespread use of traditional guideline-directed medical therapies such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone receptor antagonists, and the rates of HF-related mortality and hospitalization have remained unacceptably high. In response to a demand for novel pharmacologic agents, several therapeutic compounds have recently gained approval or are currently under review by the Food and Drug Administration. Sacubitril-valsartan has demonstrated benefit in reducing cardiovascular mortality and HF-related hospitalizations in clinical trials, while ivabradine and ferric carboxymaltose have proven efficacious in reducing HF-related hospitalizations. Lastly, the role of serelaxin in ADHF is currently under investigation in an ongoing Phase III study. While large, outcome-driven clinical trials are fundamental in informing the clinical application of these therapeutic agents, careful patient selection is imperative to ensuring similar outcomes postmarketing. In addition, optimization of current guideline-directed medical therapy remains essential as new therapies emerge and are incorporated into guideline recommendations. Additional therapeutic agents currently undergoing investigation include bucindolol hydrochloride, cimaglermin alfa, nitroxyl, omecamtiv mecarbil, TRV027, and ularitide. Clinical practitioners should remain abreast of emerging literature so that new therapeutic entities are optimally applied and positive patient outcomes are achieved. Recently introduced agents for the treatment of patients with HF include sacubitril-valsartan, ivabradine, and ferric carboxymaltose. Additional agents worthy of attention include serelaxin and other therapies currently under investigation.

Cognitive Function and Heart Failure: The Role of the Adrenergic System.

Heart Failure (HF) and cognitive impairment (CI) represent two high incident diseases worldwide, with extremely elevated mortality and morbidity rates. Their prevalence is expected to further increase in the next years due to the aging population, thus they pose enormous clinical, social and economic challenges. Sympathetic nervous system hyperactivity is known to play a pivotal role in HF pathophysiology and progression. In fact, increased cardiac and circulating catecholamine levels are responsible for several molecular and structural abnormalities with detrimental effects on the failing heart. The proof of this latter concept is represented by the clinical success of .-Blocker therapy that is able to attenuate HF-related morbidity and mortality. Recently, adrenergic system alterations have been implied also in the pathogenesis of CI and dementia opening the window for new fascinating and promising therapeutic opportunities. Assess the state of the art on the relationship between cognitive impairment and heart failure. In the present manuscript, we propose an updated review of literature and patent on the role of sympathetic nervous system derangement in the pathogenesis of HF and CI. We have discussed recent findings allowing the identification of new molecular targets that hopefully will contribute to the generation of effective therapeutic strategies for HF and dementia. In this article, the patents US20100048479, US7060871, WO2006052857, US7351401, US5721243, WO1994009155, US5449604, WO1999058981, US5985581, EP2319511, EP2377534, EP2650303, WO2006004939, WO2010132128 and EP1779858 are summarized.

Characteristics of patients with haematological and breast cancer (1996-2009) who died of heart failure-related causes after cancer therapy.

AimsTo describe the characteristics and time to death of patients with breast or haematological cancer who died of heart failure (HF) after cancer therapy. Patients with an index admission for HF who died of HF‐related causes (IAHF) and those with no index admission for HF who died of HF‐related causes (NIAHF) were compared.Methods and resultsWe performed a linked data analysis of cancer registry, death registry, and hospital administration records (n = 15 987). Index HF admission must have occurred after cancer diagnosis. Of the 4894 patients who were deceased (30.6% of cohort), 734 died of HF‐related causes (50.1% female) of which 279 (38.0%) had at least one IAHF (41.9% female) post‐cancer diagnosis. Median age was 71 years [interquartile range (IQR) 62–78] for IAHF and 66 years (IQR 56–74) for NIAHF. There were fewer chemotherapy separations for IAHF patients (median = 4, IQR 2–9) compared with NIAHF patients (median = 6, IQR 2–12). Of the IAHF patients, 71% had died within 1 year of the index HF admission. There was no significant difference in HF‐related mortality in IAHF patients compared with NIAHF (HR, 1.10, 95% CI, 0.94–1.29, P = 0.225).ConclusionsThe profile of IAHF patients who died of HF‐related causes after cancer treatment matched the current profile of HF in the general population (over half were aged ≥70 years). However, NIAHF were younger (62% were aged ≤69 years), female patients with breast cancer that died of HF‐related causes before hospital admission for HF‐related causes—a group that may have been undiagnosed or undertreated until death.

Value of Genetic Testing for the Prediction of Long-Term Outcome in Patients With Hypertrophic Cardiomyopathy

Pathogenic gene mutations are found in about 50% of patients with hypertrophic cardiomyopathy (HC). Previous studies have shown an association between sarcomere mutations and medium-term outcome. The association with long-term outcome has not been described. The aim of this cohort study was to assess the long-term outcomes of patients with genotype positive (G+) and genotype negative (G-) HC. The study population consisted of 626 patients with HC (512 probands and 114 relatives) who underwent phenotyping and genetic testing from 1985 to 2014. End points were all-cause mortality, cardiovascular (CV) mortality, heart failure (HF)-related mortality, and sudden cardiac death/aborted sudden cardiac death (SCD/aborted SCD). Kaplan-Meier and multivariate Cox regression analyses were performed. A pathogenic mutation was detected in 327 patients (52%). G+ probands were younger than G- probands (46 ± 15 vs 55 ± 15years, p <0.001), had more non sustained ventricular tachycardia (34% vs 13%; p <0.001), more often a history of syncope (14% vs 7%; p= 0.016), and more extreme hypertrophy (maximal wall thickness ≥30mm, 7% vs 1%; p <0.001). G- probands were more symptomatic (New York Heart Association ≥II, 73% vs 53%, p <0.001) and had higher left ventricular outflow tract gradients (42 ± 39 vs 29 ± 33mm Hg, p= 0.001). During 12 ± 9years of follow-up, G+ status was an independent risk factor for all-cause mortality (hazard ratio [HR] 1.90, 95% CI 1.14 to 3.15; p= 0.014), CV mortality (HR 2.82, 95% CI 1.49 to 5.36; p= 0.002), HF-related mortality (HR 6.33, 95% CI 1.79 to 22.41; p= 0.004), and SCD/aborted SCD (HR 2.88, 95% CI 1.23 to 6.71; p= 0.015). In conclusion, during long-term follow-up, patients with G+ HC are at increased risk of all-cause death, CV death, HF-related death, and SCD/aborted SCD.

Interventional heart failure: a new field.

With the rapid expansion of interventional therapies for structural heart disease, it is no surprise that the field of interventional heart failure (HF) is now an established reality. Why is there a need for interventional treatment of HF? Despite critical advances in the treatment of some forms of HF, there are still major unmet needs in the HF field (e.g., HF with preserved ejection fraction and right ventricular failure), and HF-related morbidity and mortality remain high. Furthermore, there are several advantages to device-based therapies for HF: they may help reduce polypharmacy and the need for patient compliance with pharmacotherapies, both of which continue to plague the treatment of HF. For these reasons and others, there has been a plethora of development within the interventional HF field, with therapies ranging from interatrial shunt devices to left ventricular partition devices. Here we discuss the current unmet need for interventional HF therapies, lessons learned from prior successes and challenges in the development of device-based HF therapeutics, novel interventional therapies on the horizon for HF patients, and future challenges that will be critical for all those in the field to consider when developing interventional therapies for HF.

A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms.

Heart failure (HF) is commonly described according to the severity of symptoms, using the New York Heart Association (NYHA) classification, and the assessment of ventricular function, by measuring the left ventricular ejection fraction (LVEF). It is important to acknowledge, however, that the severity of symptoms does not systematically correlate with the level of ventricular systolic dysfunction. Patients with no or only mild symptoms are still at high risk of HF-related morbidity and mortality. The objective of this review was to summarize the prevalence, characteristics, and treatment of patients with chronic HF and mild or no symptoms and to review epidemiological data from three recent registries conducted in Europe. From a clinical practice perspective, patients with a reduced ejection fraction who have only mild symptoms appear to represent a group of patients for whom the provision of adequate medical care is yet to be optimized. While prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers appears to be consistently high, the use of mineralocorticoid receptor antagonists is more variable and does not appear to be in accordance with the latest clinical guidelines. As approximately half of patients with HF and a reduced LVEF have NYHA class II symptoms, significant reductions in morbidity and mortality could be achieved by more comprehensive treatment of this population.

A randomized study of remote monitoring and fluid monitoring for the management of patients with implanted cardiac arrhythmia devices.

Only limited comparative data exist on the benefits of fluid monitoring (FM) combined with remote monitoring (RM) regarding morbidity and mortality of heart failure (HF) patients. This prospective single-centre randomized pilot study aimed to estimate the influence of RM in combination with FM on HF hospitalizations as well as ventricular tachyarrhythmias and mortality. Patients with standard indication for implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy and defibrillator were implanted with devices capable of RM and FM, and were followed for 15 months. Subjects were randomly allocated to RM including OptiVol and predefined management of alerts (remote group), or standard in-office visits every 3 months (control group). A total of 176 patients (77% male; 66 ± 12 years; left ventricular ejection fraction (LVEF) 32 ± 11%; ischemic cardiomyopathy 50%; CRT device 50%; primary prevention 85%) were analysed. Cox proportional hazard analysis on the time to first HF-related hospitalization showed a hazard ratio of 1.23 [0.62-2.44] (P = 0.551) favouring the control group. In the remote group, 13 patients (15%) experienced ICD shocks vs. 10 patients (11%) in the control group (P = 0.512). The average time to first ICD shock was 212 ± 173 days in the remote arm and 212 ± 143 days in the control arm (P = 0.994). The Kaplan-Meier estimate of mortality after 1 year was 8.6% (eight deaths) in the remote group vs. 4.6% in the control group (six deaths; P = 0.502). In a single-centre randomized pilot study of RM in combination with FM, no significant influence on HF-related hospitalizations, ICD shocks, or mortality was found.

Abstract 284: Association of Worsening Renal Function With Mortality and Heart Failure Readmissions in Patients Hospitalized With Acute Heart Failure

Background: The impact of worsening renal function (WRF) on heart failure (HF)-related readmissions (HFR) and HF-related mortality among hospitalized acute HF patients was examined. Methods: A patient’s first acute HF hospitalization event (index) was identified in Cerner Health Facts® database (Jan 2008–March 2011). Patients were categorized as WRF (serum creatinine ≥0.3 mg/dL and ≥25% increase from baseline) persisting at discharge (WRFp), not persisting at discharge (WRFt), or non WRF. Outcomes were compared for the index hospitalization and cumulatively at 30, 180, and 365 days post discharge. Generalized linear model (HFR count) and logistic regression models (mortality) were constructed. Results: The acute HF patients (77% [42,507 of 55,436] non WRF, 10% [5,563 of 55,436] WRFp, and 13% [7,366 of 55,436] WRFt) were 53% [29,442 of 55,436] female with a mean age of 72.4 (±14.3) years. WRFp had higher index mortality rates (23.6% [1,312 of 5,563] vs 5.7% [418 of 7,366] vs 3.9% [1,673 of 42,507], P&lt;0.0001) than WRFt and non WRF patients, respectively. For mortality, 70% [3,403 of 4,883] of deaths occurred at the index hospitalization. WRFp and WRFt patients combined had higher 30-day HFR counts than non WRF patients (0.12 vs 0.09, P&lt;0.0001), but there was no difference between WRFp and WRFt. These observations were consistent across all cumulative time points and confirmed by multivariable analyses. Conclusion: Acute HF patients with WRF were more likely to die or be readmitted than non WRF patients. WRFp patients experienced higher HF-related mortality rates than WRFt patients but there were no differences in HFR between WRFt and WRFp.

Mechanisms and clinical consequences of untreated central sleep apnea in heart failure.

Central sleep apnea (CSA) is a highly prevalent, though often unrecognized, comorbidity in patients with heart failure (HF). Data from HF population studies suggest that it may present in 30% to 50% of HF patients. CSA is recognized as an important contributor to the progression of HF and to HF-related morbidity and mortality. Over the past 2 decades, an expanding body of research has begun to shed light on the pathophysiologic mechanisms of CSA. Armed with this growing knowledge base, the sleep, respiratory, and cardiovascular research communities have been working to identify ways to treat CSA in HF with the ultimate goal of improving patient quality of life and clinical outcomes. In this paper, we examine the current state of knowledge about the mechanisms of CSA in HF and review emerging therapies for this disorder.

Diuretic Therapy in Heart Failure - Current Approaches.

The use of diuretics is common in patients with heart failure (HF), to relieve the congestive symptoms of HF. Although they are widely used, there are limited data on their ability to modulate HF-related morbidity and mortality. Diuretic efficacy may be limited by adverse neurohormonal activation and by 'congestion-like' symptoms. Diuretics are an extremely useful and varied class of agent for the management of hypervolaemic states. This review summarises the basic features of diuretics, including their mechanism of action, indications and adverse effects in heart failure.

Management of pulmonary hypertension due to heart failure with preserved ejection fraction.

Heart failure with preserved ejection fraction (HFpEF) is a major cause of HF-related morbidity and mortality, with no medical therapy proven to modify the underlying disease process and result in improvements in survival. With long-standing pulmonary venous congestion, a majority of HFpEF patients develop pulmonary hypertension (PH). Elevated pulmonary pressures have been shown to be a major determinant of mortality in this population. Given the paucity of available disease-modifying therapies for HFpEF, there has been a considerable interest in evaluating new therapeutic options specifically targeting PH in this patient population.

Coping styles associated with heart failure outcomes: A systematic review

Background: The incidence of heart failure continues to rise in the United States, with more than 600,000 new cases diagnosed each year. The progressive nature of heart failure predisposes individuals to physical and psychological sequelae, including physical activity intolerance and depressive symptoms. Coping is beneficial in assisting individuals to live with heart failure. Evidence suggests that how individuals cope with heart failure may influence heart failure-related outcomes, such as psychological well-being, self-care, health-related quality of life, and mortality. Thus, a better under- standing of coping styles can assist clinicians and researchers to develop interventions that improve heart failure outcomes. Purpose: To provide a systematic review and synthesis of evidence regarding the influence of coping styles in HF. A conceptualization of coping commonly used in heart failure-related literature within the context of stress and cognitive appraisal of stress is described. In addition, this review will identify what is known about: (1) individual factors that influence coping styles in heart failure; (2) the influence of coping styles on heart failure-related outcomes; and (3) interventions that promote effective (e.g., problem-focused) coping in heart failure. Methodological issues associated with this empirical literature and implications for clinicians and research also were discussed. Methods: This article provides a systematic review of current empirical evidence regarding the influence of coping styles on heart failure-related outcomes. Results: This review of empirical literature revealed several factors that may influence coping style in individuals with HF, including co-morbidities, personality, illness knowledge and beliefs, and sense of coherence. Additionally, the use of problem-focused coping strategies was found to be related to positive HF outcomes, such as psychological well-being, enhanced self-care, and improved health-related quality of life. Whereas, the use of emotion-focused coping strategies was found to be associated with negative HF outcomes, such as psychological distress, decreased health-related quality of life, and increased HF-related mortality. Although limited, experimental work in this area suggests that problem-focused coping strategies may be beneficial in improving HF-related outcomes. Conclusions: Effective coping aids the successful management of heart failure, specifically the management of associated physical symptoms and psychological sequelae that may result. Problem-focused strategies may be more beneficial than emotion-focused strategies in assisting individuals to cope with heart failure and improve heart failure outcomes, such as psychological well-being, self-care, and health-related quality of life. Conversely, emotion-focused strategies may nega- tively influence heart failure outcomes, such as psychological distress, decreased health-related quality of life, and heart failure-related mortality. Therefore, nurses should include problem-focused coping strategies in patient and family education. Research on the effectiveness of problem-focused strategies is sparse, thus more experimental studies, particularly longitudinal designs, is warranted to determine the efficacy of problem-focused interventions throughout the progression of heart failure.

Stiff Heart and Stiff Arteries. Could We Soften Both?

Old age, female gender, hypertension (HTN), cardiac ischaemia, and arterial stiffness (AS) are the main determinants of a stiff heart, diastolic dysfunction (DD), and finally heart failure with preserved ejection fraction (HFpEF); however, several cardiac or extra-cardiac pathologies may also be involved. The combined ventricular-arterial stiffening (abnormal left ventricle-arterial coupling) is the main determinant of the increased prevalence of HFpEF in elderly persons, particularly women, and in younger subjects with HTN. Hospitalization and mortality rates in patients with HFpEF are similar to those of patients with heart failure with reduced EF (HFrEF). However, although the prognosis of HFrEF has improved over time, the optimal treatment of HFpEF remains unclear, because of the differences in the pathophysiology of the two syndromes. A number of new drugs have shown promise but they will not be commercially available for several years. For the time being, aggressive treatment of non-cardiac comorbidities is the only option available for the management of HFpEF. Treatment of anaemia, sleep disorders, chronic kidney disease, non-alcoholic fatty liver disease, atrial fibrillation, diabetes mellitus, and judicious use of diuretics are effective to some degree. Statin treatment deserves special attention, regardless of the presence of dyslipidaemia, because it has been shown, mainly in small studies, post hoc analyses, and in a large recent meta-analysis, that it is related to an improved quality of life and a reduction in HF-related mortality. We urgently need to utilize these recourses to relieve a substantial number of patients suffering from HFpEF, a disease with an ominous prognosis.

Epidemiology of Heart Failure

Heart failure (HF) has been singled out as an epidemic and is a staggering clinical and public health problem, associated with significant mortality, morbidity, and healthcare expenditures, particularly among those aged ≥ 65 years. The case mix of HF is changing over time with a growing proportion of cases presenting with preserved ejection fraction for which there is no specific treatment. Despite progress in reducing HF-related mortality, hospitalizations for HF remain frequent and rates of readmissions continue to rise. To prevent hospitalizations, a comprehensive characterization of predictors of readmission in patients with HF is imperative and must integrate the impact of multimorbidity related to coexisting conditions. New models of patient-centered care that draw on community-based resources to support HF patients with complex coexisting conditions are needed to decrease hospitalizations.

Diuretic Use in Heart Failure and Outcomes

Diuretics are frequently administered to relieve congestive symptoms in patients with heart failure (HF). Despite their widespread use, prospective data on the potential of diuretics to modulate HF-related morbidity and mortality are scarce. Diuretic efficacy may be limited by adverse neurohormonal activation and by "congestion-like" symptoms that may occur in the absence of fluid overload. Herein, we review the current knowledge on diuretic use and outcomes in HF.

Using Biomarkers to “Guide” Heart Failure Management

Over the last several years, cardiac biomarkers have proven to be increasingly useful for disease screening, diagnosis, and prognostication. The most widely used biomarkers in heart failure (HF) are natriuretic peptides (NPs), which can aid in diagnosing HF, while also identifying those who are at higher risk of adverse outcomes. Multiple clinical trials have investigated the role of NPs as therapeutic targets for HF management, but results have been conflicting. Collectively, however, the data suggest that NP levels may be useful in guiding HF management and improving HF-related morbidity and mortality. In this review, we summarize existing data investigating the use of NPs as targets for outpatient HF therapy, focusing on differences in study designs and lessons learned from the results. Although the results for this approach are promising overall, we propose that additional well-designed prospective randomized controlled trials-specifically incorporating the relevant lessons learned from previous studies-are necessary to pivotally establish the role of NP-guided outpatient HF management.

Persistence of thyroid hormones disorders in chronic heart failure out patients: “Heart hypothyroidism”

Although progress in understanding heart failure (HF) has been considerable in recent decades, mortality rates remain high, and estimated increases in HF-related morbidity and mortality suggest that our understanding of the pathophysiological mechanisms of this syndrome is inadequate. Thyroid hormones (THs) regulate cardiac performance by acting on the heart and vascular system, and maintenance of THs homeostasis is required for proper cardiovascular function [1,2].

Surgical ventricular restoration for the treatment of heart failure

Heart failure (HF) is an emerging epidemic affecting 15 million people in the USA and Europe. HF-related mortality was unchanged between 1995 and 2009, despite a decrease in the incidence of cardiovascular disease. Conventional explanations include an aging population and improved treatment of acute myocardial infarction and HF. An adverse relationship between structure and function is the central theme in patients with systolic dysfunction. The normal elliptical ventricular shape becomes spherical in ischemic, valvular, and nonischemic dilated cardiomyopathy. Therapeutic decisions should be made on the basis of ventricular volume rather than ejection fraction. When left ventricular end-systolic volume index exceeds 60 ml/m², medical therapy, CABG surgery, and mitral repair have limited benefit. This form-function relationship can be corrected by surgical ventricular restoration (SVR), which returns the ventricle to a normal volume and shape. Consistent early and late benefits in the treatment of ischemic dilated cardiomyopathy with SVR have been reported in >5,000 patients from various international centers. The prospective, randomized STICH trial did not confirm these findings and the reasons for this discrepancy are examined in detail. Future surgical options for SVR in nonischemic and valvular dilated cardiomyopathy, and its integration with left ventricular assist devices and cell therapy, are described.

Nurse-Led Case Management Cuts Heart Failure Readmissions

For patients discharged after hospitalization for heart failure, case-management interventions led by a specialist nurse reduce HF-related readmissions, HF-related mortality, and all-cause mortality, according to an update published online in the Cochrane Database of Systematic Reviews. The initial Cochrane Review that addressed the effectiveness of three different types of follow-up care (case management, clinic-based, and multidisciplinary) after hospitalization for HF was published in 2005, and found mixed and inconclusive results for all three. Since then, several new clinical trials have been performed, and “there is now strong evidence that case-management interventions are associated with a substantial, statistically significant reduction in all-cause mortality” as well as HF mortality and rehospitalization, said Dr. Andrea Takeda of Queen Mary University, London, and her associates in the Cochrane Collaboration. In contrast, the evidence doesn't support interventions in which the major component is follow-up in a hospital HF clinic. And the evidence for multidisciplinary interventions is too sparse to be conclusive because only two high-quality studies have examined these approaches, the investigators wrote (Cochrane Database of Syst. Rev. 2012;9:CD002752). Case-management programs led by personnel other than nurses specializing in HF, such as hospital-based or community pharmacists, nonspecialist nurses, or interdisciplinary teams, were not as successful as those led by specialist nurses, they added. Dr. Takeda and her colleagues reviewed 25 randomized clinical trials of at least 6 months' duration that compared the three types of interventions against usual care in 5,942 adults who had been hospitalized for HF. They excluded interventions that focused on patient education only, exercise only, telemedicine (which was examined in a separate Cochrane Review), or cardiac rehabilitation. Most of the clinical trials had 100−350 study subjects, but some had fewer than 100 and one had over 1,000 subjects. They were conducted in Europe, the United States, Canada, Australia, and China. Seventeen studies assessed case-management interventions. Pooling the results demonstrated that these interventions produced a substantial and highly significant reduction in all-cause mortality, HF-related mortality, and HF-related rehospitalization at 12 months. Although the overall impact of the interventions on inpatient days was “not clear,” the researchers wrote, there was “a strong suggestion” that these interventions decreased hospital length of stay. However, case-management interventions did not appear to improve event-free survival. They also did not appear to improve health-related quality of life, but few studies examined this outcome and those that did suffered from high dropout rates, so the data were inconclusive. Only six clinical trials involving 1,486 patients assessed clinic-based interventions. They showed no reduction in readmissions, mortality, inpatient days, event-free survival, or health-related quality of life. Only two clinical trials involving 403 patients assessed multidisciplinary programs. The data were inadequate to establish conclusive results, Dr. Takeda and her associates wrote. In a posthoc analysis, the intensity of various interventions did not appear to influence their effectiveness. Studies of the most intensive, moderately intensive, and low-intensity interventions all showed some reductions in mortality and rehospitalization, the researchers added. No financial conflict of interest was reported by the authors.

Risk of Heart Failure Complication During Hospitalization for Acute Myocardial Infarction in a Contemporary Population

Background— Patients with acute myocardial infarction (MI) complicated by heart failure (HF) are subject to higher mortality during the index hospitalization. Early risk prediction and intervention may help prevent HF-related morbidity and mortality. Methods and Results— We examined 77 675 ST-elevation MI and 110 128 non-ST-elevation patients with MI without cardiogenic shock or HF at presentation treated at 609 hospitals in Acute Coronary Treatment and Intervention Outcomes Network Registry (ACTION) Registry-Get With The Guidelines between January 1, 2007, and March 31, 2011. Logistic regression identified patient characteristics associated with development of in-hospital HF. Overall, 3.8% of patients with MI developed in-hospital HF, which was associated with higher mortality in both ST-elevation MI and non-ST elevation MI. In multivariable logistic regression, left ventricular ejection fraction ≤30%, prior HF, diabetes mellitus, female sex, ST-elevation MI, and hypertension (all P &lt;0.005) were independently associated with in-hospital HF. Patients who developed HF during non-ST-elevation MI were more likely to be medically managed without catheterization (30% versus 13% with HF, P &lt;0.0001) or had longer delays to surgical or percutaneous revascularization. Patients with ST-elevation MI and HF were less likely to receive primary percutaneous coronary revascularization (84% versus 79% with HF, P &lt;0.0001), and more likely to receive thrombolytic therapy (14% versus 11%; P =0.0001). Conclusions— Patients with MI who develop HF during hospitalization have a higher risk clinical profile and greater mortality, but may be less likely to receive revascularization in a timely fashion. Targeting these highest risk patients may improve outcome post-MI.