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    In-hospital management and outcomes of acute coronary syndromes in relation to prior history of heart failure

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    Authors
    Zhang, Hanfei
    Goodman, Shaun G.
    Yan, Raymond T.
    Steg, Phillippe Gabriel
    Kornder, Jan M.
    Gyenes, Gabor
    Grondin, Francois R.
    Brieger, David
    DeYoung, J. Paul
    Gallo, Richard
    Yan, Andrew T.
    Show allShow less
    UMass Chan Affiliations
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2015-03-12
    Keywords
    Cardiology
    Cardiovascular Diseases
    Epidemiology
    Health Services Administration
    Health Services Research
    
    Metadata
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    Link to Full Text
    http://dx.doi.org/10.1177/2048872615574109
    Abstract
    INTRODUCTION: The prognostic significance of prior heart failure in acute coronary syndromes has not been well studied. Accordingly, we evaluated the baseline characteristics, management patterns and clinical outcomes in patients with acute coronary syndromes who had prior heart failure. METHODS AND RESULTS: The study population consisted of acute coronary syndrome patients in the Global Registry of Acute Coronary Events, expanded Global Registry of Acute Coronary Events and Canadian Registry of Acute Coronary Events between 1999 and 2008. Of the 13,937 eligible patients (mean age 66±13 years, 33% female and 28.3% with ST-elevation myocardial infarction), 1498 (10.7%) patients had a history of heart failure. Those with prior heart failure tended to be older, female and had lower systolic blood pressure, higher Killip class and creatinine on presentation. Prior heart failure was also associated with significantly worse left ventricular systolic function and lower rates of cardiac catheterization and coronary revascularization. The group with previous heart failure had significantly higher rates of acute decompensated heart failure, cardiogenic shock, myocardial (re)infarction and mortality in hospital. In multivariable analysis, prior heart failure remained an independent predictor of in-hospital mortality (odds ratio 1.48, 95% confidence interval 1.08-2.03, p=0.015). CONCLUSIONS: Prior heart failure was associated with high risk features on presentation and adverse outcomes including higher adjusted in-hospital mortality in acute coronary syndrome patients. However, acute coronary syndrome patients with prior heart failure were less likely to receive evidence-based therapies, suggesting potential opportunities to target more intensive treatment to improve their outcome.
    Source
    Zhang H, Goodman SG, Yan RT, Steg PG, Kornder JM, Gyenes GT, Grondin FR, Brieger D, DeYoung JP, Gallo R, Yan AT; Canadian GRACE and CANRACE Investigators. In-hospital management and outcomes of acute coronary syndromes in relation to prior history of heart failure. Eur Heart J Acute Cardiovasc Care. 2015 Mar 12. doi:10.1177/2048872615574109. [Epub ahead of print] PubMed PMID: 25766512.
    DOI
    10.1177/2048872615574109
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27192
    PubMed ID
    25766512
    Related Resources
    Link to article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1177/2048872615574109
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