15-Year trends, predictors, and outcomes of heart failure hospitalization complicating first acute myocardial infarction in the modern percutaneous coronary intervention era

Aims: Heart failure (HF) following acute myocardial infarction (AMI) is a global health concern, but data on risk factors associated with HF hospitalization post-AMI are limited. Methods and results: We analysed data from the Myocardial Ischaemia National Audit Project, including patients admitted with AMI from 1 January 2006 to 31 March 2019. Data linkage with Hospital Episode Statistics Admitted Patient Care and the Office for National Statistics facilitated a longitudinal analysis. High-risk patients were identified using dapagliflozin in patients without diabetes mellitus with acute myocardial infarction (DAPA-MI) and EMPAgliflozin on Hospitalization for Heart Failure and Mortality in Patients With aCuTe Myocardial Infarction (EMPACT-MI) criteria. We assessed clinical outcomes, adherence to European Society of Cardiology quality indicators, and predictors of HF-related hospitalizations. Out of 1 046 480 AMI patients, 9.1% overall, 17.2% in the DAPA-MI cohort, and 16.6% in the EMPACT-MI cohort experienced HF hospitalization within a year post-AMI. High-risk patients, defined by the presence of five risk factors, had nearly one in four hospitalizations with HF at 1-year follow-up. The predicted adjusted incidence rate for heart failure within 1 year almost doubled from 64.5 cases per 1000 person-years [95% confidence interval (CI): 51.1 to 78.0] in 2005, to 118.2 cases per 1000 person-years in 2019 (95% CI: 115.0 to 121.5). Heart failure hospitalization was associated with a three-fold increase in 1-year mortality (hazard ratio 3.01, 95% CI 2.95-3.13). Conclusion: One in 10 AMI patients experienced HF hospitalization within the first-year post-AMI, with rising trends in high-risk subgroups. These findings highlight the need for targeted post-AMI care strategies to improve outcomes and address the increasing burden of HF in the modern percutaneous coronary intervention era.