Atypical Symptoms on Admission Predict Progression to Heart Failure in Patients with First-Time Myocardial Infarction: Using Data from the Korean Multicenter Cohort Registry

Abstract

Background: Identifying the initial factors predicting heart failure (HF) progression in patients with myocardial infarction (MI), a major cause of HF, is essential. Objectives: We aimed to examine predictors of rehospitalization due to HF in patients with first-time MI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) prospective cohort between 2011 and 2015. Methods: A secondary data analysis was conducted on a population of 8888 patients who completed 3 years of follow-up and had no history of MI, HF, or death. The HF group was defined as patients rehospitalized with an HF diagnosis due to worsening symptoms. A 1:4 propensity score matching analysis was performed on 11 baseline characteristics, and the clinical conditions and complications of the HF group (n = 252) were compared with the non-HF group (n = 991). Statistical analyses were performed using SAS version 9.4 and R version 4.2.3. Results: A Cox proportional hazards model showed that the factors predicting rehospitalization due to HF were dyspnea (HR, 1.54; 95% CI, 1.16–2.04; P = .003), left ventricular ejection fraction <50% (HR, 2.71; 95% CI, 2.06–3.58; P < .001), and new-onset HF confirmed during hospitalization (HR, 1.77; 95% CI, 1.18–2.66; P = .006). Atypical chest pain (no chest pain) was significant only in univariate analysis. Conclusions: This study highlights the importance of carefully monitoring symptoms and conditions during outpatient follow-up in post-MI patients, regardless of age, sex, or medical history. In particular, those who present with dyspnea at admission or develop new-onset HF during hospitalization should be considered high-risk for HF rehospitalization.