An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors.

Gho, Johannes M I H Schmidt, Amand F Pasea, Laura Koudstaal, Stefan Pujades-Rodriguez, Mar Denaxas, Spiros Shah, Anoop D Patel, Riyaz S Gale, Chris P Hoes, Arno W Cleland, John G Hemingway, Harry Asselbergs, Folkert W

REVIEW


15 May 2018

This study is not particularly innovative nor is it particularly surprising that twice-daily injections infer lower persistence than weekly doses. However, it does have some clinical relevance. I would have liked to have seen a separate comparison of short-acting and longer acting GLP-1RAs rather than simply grouping them together.


RELEVANCE 1
INNOVATIVENESS 3
APPLICABILITY 4
OVERALL 3

PAPER DETAILS


TITLE

An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors.

ABSTRACT

OBJECTIVES
To investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of patients with MI using routinely collected primary and hospital care electronic health records (EHRs).

METHODS
Data were used from the CALIBER programme, linking EHRs in England from primary care, hospital admissions, an MI registry and mortality data. Subjects were eligible if they were 18 years or older, did not have a history of HF and survived a first MI. Factors associated with time to HF were examined using Cox proportional hazard models.

RESULTS
Of the 24 479 patients with MI, 5775 (23.6%) developed HF during a median follow-up of 3.7 years (incidence rate per 1000 person-years: 63.8, 95% CI 62.2 to 65.5). Baseline characteristics significantly associated with developing HF were: atrial fibrillation (HR 1.62, 95% CI 1.51 to 1.75), age (per 10 years increase: 1.45, 1.41 to 1.49), diabetes (1.45, 1.35 to 1.56), peripheral arterial disease (1.38, 1.26 to 1.51), chronic obstructive pulmonary disease (1.28, 1.17 to 1.40), greater socioeconomic deprivation (5th vs 1st quintile: 1.27, 1.13 to 1.41), ST-segment elevation MI at presentation (1.19, 1.11 to 1.27) and hypertension (1.16, 1.09 to 1.23). Results were robust to various sensitivity analyses such as competing risk analysis and multiple imputation.

CONCLUSION
In England, one in four survivors of a first MI develop HF within 4 years. This contemporary study demonstrates that patients with MI are at considerable risk of HF. Baseline patient characteristics associated with time until HF were identified, which may be used to target preventive strategies.



AUTHOR(S)

Gho, Johannes M I H Schmidt, Amand F Pasea, Laura Koudstaal, Stefan Pujades-Rodriguez, Mar Denaxas, Spiros Shah, Anoop D Patel, Riyaz S Gale, Chris P Hoes, Arno W Cleland, John G Hemingway, Harry Asselbergs, Folkert W

JOURNAL

BMJ open

PLACE

England