期刊
BMJ OPEN
卷 8, 期 3, 页码 -出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/bmjopen-2017-018331
关键词
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资金
- National Institute for Health Research [RP-PG-0407-10314]
- Wellcome Trust [086091/Z/08/Z]
- Medical Research Council Prognosis Research Strategy Partnership [G0902393/99558]
- Farr Institute of Health Informatics Research - Medical Research Council [MR/K006584/1]
- Arthritis Research UK
- British Heart Foundation
- Cancer Research UK
- Economic and Social Research Council
- Engineering and Physical Sciences Research Council
- National Institute of Health Research
- National Institute for Social Care and Health Research (Welsh Assembly Government)
- Chief Scientist Office (Scottish Government Health Directorates)
- Wellcome Trust
- Innovative Medicines Initiative 2 Joint Undertaking [116074]
- UCLH NIHR Biomedical Research Centre
- NIHR University College Hospitals/University College London Biomedical Research Centre
- Dekker scholarship-Netherlands Heart Foundation [2014T001]
- UCL Hospitals NIHR Biomedical Research Centre
- British Heart Foundation [FS/14/76/30933] Funding Source: researchfish
- Medical Research Council [MR/K006584/1, MC_PC_13041, HDR-9003, HDR-9002] Funding Source: researchfish
- National Institute for Health Research [CL-2011-11-003, RP-PG-0407-10314] Funding Source: researchfish
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 Ml. Factors associated with time to HF were examined using Cox proportional hazard models. Results Of the 24 479 patients with Ml, 5775 (23.6%) developed HF during a median follow-up of 3.7 years (incidence rate per 1000 person-years: 63.8, 95% Cl 62.2 to 65.5). Baseline characteristics significantly associated with developing HF were: atrial fibrillation (HR 1.62, 95% Cl 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 4years. 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.
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