Prior heart failure among patients with acute coronary syndromes is associated with a higher incidence of in-hospital heart failure

Background. There are few data regarding the impact of prior heart failure (P-HF) on the presentation, course and outcomes of acute coronary syndromes (ACS). Methods and Results. We prospectively analyzed all ACS patients admitted in all cardiology wards in Israel during February and March, 2004. Of the 2098 patients, 156(7.4%) had P-HF. These patients were older (75 [66.5-81] versus 63 [53-74] years, (P < 0.001)) and more often female (38.5% versus 25.0%, P < 0.001)), with a higher prevalence of coronary artery disease risk factors, prior cardiac disease and procedures, and other co-morbidities. They more often presented with atypical angina and heart failure and less with ST-elevation (18.6% versus 51.3%, p < 0.0001). In-hospital heart failure developed more frequently (15.4% versus 6.1%, p = 0.00001), including cardiogenic shock (7.1% versus 2.9%, p = 0.005), as did persistent atrial fibrillation (6.4% versus 0.7%, p < 0.001), but not ischemic complications. After adjustment for differences, P-HF was not independently associated with 30 day or six-month mortality, but at one-year follow-up, it was (OR 1.16, 95% CI 1.0-2.5). P-HF was also independently associated with increased incidence of heart failure upon admission or thereafter in-hospital (OR = 4.3, 95% CI 2.8-6.6). Conclusions. P-HF ACS patients had high-risk features, lower incidence of ST-elevation, and higher one-year adjusted mortality. P-HF was also independently associated with in-hospital heart failure, suggesting they should be monitored vigilantly.