Hospital Medicine

Heart Failure Status at Presentation for ACS Predicts 1-Year Outcomes

Heart failure can predict recurrent ischemia and rehospitalization for heart failure in patients with acute coronary syndrome (ACS), according to a new study presented at the American Heart Association’s Scientific Sessions 2021.

Of those presenting with ACS, 11% had evidence of acute heart failure, although more than half of this group (55%) had no history of heart failure.

Although heart failure often complicates ACS, data on recurrent ischemic events and rehospitalization for heart failure in patients with ACS are limited. Therefore, the researchers assessed the association between heart failure status at presentation for ACS and future ischemic events, rehospitalization for heart failure, and death 1 year after discharge from the hospital.

To do so, the researchers conducted a Cox proportional hazards analysis of pooled data from 4 randomized clinical trials with a combined total of 47,474 patients with ACS. The analysis consisted of the APPRAISE-2, PLATO, TRA-CER, and TRILOGY ACS trials. In addition, the researchers estimated cumulative event rates by using a cumulative incidence function. Heart failure status at presentation for ACS included history of heart failure, de novo heart failure, and no heart failure.

Overall, the researchers found that patients with previous or chronic heart failure were nearly 6 times more likely to present with acute heart failure (40%) than patients with no previous heart failure (7%).

Data analysis indicated that, after 1 year post-discharge, patients with prior and de novo heart failure were at statistically significantly increased risk for all-cause mortality, major adverse cardiovascular events, recurrent myocardial infarction, and stroke as well as for rehospitalization for heart failure, compared with those without heart failure.

According to the researchers, “These findings highlight the need for improved strategies to prevent and manage adverse outcomes in this high-risk population.”

—Ellen Kurek


Goodwin N, Clare RM, Wojdyla D, et al. Worse clinical outcomes in patients with acute coronary syndrome and prior or new onset heart failure: insights from 47,474 patients in a pooled analysis of randomized clinical trials. Paper presented at: American Heart Association Scientific Sessions 2021; November 13-15, 2021; Virtual.!/9349/presentation/8528