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BMJ Open. 2018 Mar 3;8(3):e018331. doi: 10.1136/bmjopen-2017-018331.

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

Author information

1
Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, UK.
2
Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
3
Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.
4
Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
5
Medical Research Council Bioinformatics Centre, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
6
Medical Research Council Bioinformatics Centre, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
7
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
8
National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College London, London, UK.
9
Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands.

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.

KEYWORDS:

electronic health records; heart failure; myocardial infarction

PMID:
29502083
PMCID:
PMC5855447
DOI:
10.1136/bmjopen-2017-018331
[Indexed for MEDLINE]
Free PMC Article

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