BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Public Health Scotland, Edinburgh, UK.
Eur J Heart Fail. 2023 Aug;25(8):1213-1224. doi: 10.1002/ejhf.2965. Epub 2023 Jul 17.
Mortality from acute myocardial infarction (AMI) has declined, increasing the pool of survivors at risk of later development of heart failure (HF). However, coronary reperfusion limits infarct size and secondary prevention therapies have improved. In light of these competing influences, we examined long-term trends in the risk of HF hospitalization (HFH) following a first AMI occurring in Scotland over 25 years.
All patients in Scotland discharged alive after a first AMI between 1991 and 2015 were followed until a first HFH or death until the end of 2016 (minimum follow-up 1 year, maximum 26 years). A total of 175 672 people with no prior history of HF were discharged alive after a first AMI during the period of study. A total of 21 445 (12.2%) patients had a first HFH during a median follow-up of 6.7 years. Incidence of HFH (per 1000 person-years) at 1 year following discharge from a first AMI decreased from 59.3 (95% confidence interval [CI] 54.2-64.7) in 1991 to 31.3 (95% CI 27.3-35.8) in 2015, with consistent trends seen for HF occurring within 5 and 10 years. Accounting for the competing risk of death, the adjusted risk of HFH at 1 year after discharge decreased by 53% (95% CI 45-60%), with similar decreases at 5 and 10 years.
The incidence of HFH following AMI in Scotland has decreased since 1991. These trends suggest that better treatment of AMI and secondary prevention are having an impact on the risk of HF at a population level.
急性心肌梗死（AMI）的死亡率已经下降，这增加了那些以后可能发展为心力衰竭（HF）的幸存者的数量。然而，冠状动脉再灌注限制了梗塞面积，并且二级预防治疗也得到了改善。鉴于这些相互竞争的影响，我们研究了在苏格兰 25 年间首次发生 AMI 后 HF 住院（HFH）风险的长期趋势。
在 1991 年至 2015 年间首次 AMI 存活出院的所有苏格兰患者均进行了随访，直至首次 HFH 或死亡，直至 2016 年底（最低随访 1 年，最长 26 年）。在研究期间，共有 175672 名无 HF 既往史的患者首次 AMI 存活出院。在中位随访 6.7 年期间，共有 21445 名（12.2%）患者首次发生 HFH。首次 AMI 出院后 1 年时 HFH 的发生率（每 1000 人年）从 1991 年的 59.3（95%置信区间[CI] 54.2-64.7）下降到 2015 年的 31.3（95%CI 27.3-35.8），5 年和 10 年内的趋势一致。考虑到死亡的竞争风险，出院后 1 年时 HFH 的调整风险降低了 53%（95%CI 45-60%），5 年和 10 年时的风险也降低了。
自 1991 年以来，苏格兰 AMI 后 HFH 的发生率有所下降。这些趋势表明，AMI 的治疗和二级预防的改善正在对人群水平的 HF 风险产生影响。
