A large British population study has suggested that survivors of heart attacks could face a greater risk of developing further serious health conditions for 10 years afterwards, and could benefit from additional support and monitoring in the years after diagnosis.
They said while the greatest risk was heart failure and atrial fibrillation, the risk of other conditions such as kidney failure also increased, and that future studies should focus on identifying those with the greatest risk of adverse health conditions, and the development of new strategies for prevention and early diagnosis.
The study by academics at the University of Leeds – part-funded by the British Heart Foundation (BHF) and Wellcome – had analysed records of adults admitted to one of 229 NHS trusts in England between 1 January 2008 and 31 January 2017.
The Independent reports that 34 116 257 individuals contributng to 145 912 852 hospitalisations were included. Of 145.9m records, 433 361 individuals had suffered a heart attack for the first time.
The researchers looked at their health outcomes over nine years compared with a control group of 2m people of the same age and sex who had not had a heart attack.
The most likely condition was heart failure at 29.6%, compared with 9.8% in the control group.
However, kidney failure developed in 27.2% of heart attack survivors compared with 19.8% of other patients.
New hospitalisation for diabetes was also higher at 17% compared with 14.3% among patients who had not had a heart attack.
Lead author Dr Marlous Hall said there are “around 1.4m” heart attack survivors in the UK at risk of “further serious health conditions”.
Hall, who is an associate professor of cardiovascular epidemiology at Leeds’ School of Medicine and multimorbidity research in the Leeds Institute for Data Analytics (LIDA), added: “Effective communication of the likely course of disease and risk of adverse long-term outcomes between patients and healthcare professionals can promote positive lifestyle changes, encourage patients to stick to treatment and improve patient understanding and quality of life.”
The BHF estimates that 100 000 people are admitted to hospital with heart attacks every day in the UK, and around seven out of 10 patients now survive them.
“Our study highlights the need for individual care plans to be revised to take into account the higher demand for care caused by survivorship,” Hall said.
The analysis showed the increased risk of heart failure among heart attack patients was 393%, while atrial fibrillation risk was 98%.
They were also found to be at a 77% greater risk of kidney failure, a 13% greater risk of vascular dementia and a 6% greater risk of depression.
The risk of cancer was lower overall among heart attack patients, according to the study, which was published in PLOS Medicine.
Professor Bryan Williams, chief scientific and medical officer at the BHF, said: “Particularly after a major heart attack, people can be left with irreparable damage to their heart, putting them at increased risk of heart failure.”
“This study sheds further light on how heart attacks are associated with increased risk of developing other serious health conditions.”
Study details
Health outcomes after myocardial infarction: A population study of 56 million people in England
Marlous Hall, Lesley Smith, Chris Gale, et al.
Published in PLOS Medicine on 15 February 2024
Abstract
Background
The occurrence of a range of health outcomes following myocardial infarction (MI) is unknown. Therefore, this study aimed to determine the long-term risk of major health outcomes following MI and generate sociodemographic stratified risk charts in order to inform care recommendations in the post-MI period and underpin shared decision making.
Methods and findings
This nationwide cohort study includes all individuals aged ≥18 years admitted to one of 229 National Health Service (NHS) Trusts in England between 1 January 2008 and 31 January 2017 (final follow-up 27 March 2017). We analysed 11 non-fatal health outcomes (subsequent MI and first hospitalisation for heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes mellitus, dementia, depression, and cancer) and all-cause mortality. Of the 55,619,430 population of England, 34,116,257 individuals contributing to 145,912,852 hospitalisations were included (mean age 41.7 years (standard deviation [SD 26.1]); n = 14,747,198 (44.2%) male). There were 433,361 individuals with MI (mean age 67.4 years [SD 14.4)]; n = 283,742 (65.5%) male). Following MI, all-cause mortality was the most frequent event (adjusted cumulative incidence at 9 years 37.8% (95% confidence interval [CI] [37.6,37.9]), followed by heart failure (29.6%; 95% CI [29.4,29.7]), renal failure (27.2%; 95% CI [27.0,27.4]), atrial fibrillation (22.3%; 95% CI [22.2,22.5]), severe bleeding (19.0%; 95% CI [18.8,19.1]), diabetes (17.0%; 95% CI [16.9,17.1]), cancer (13.5%; 95% CI [13.3,13.6]), cerebrovascular disease (12.5%; 95% CI [12.4,12.7]), depression (8.9%; 95% CI [8.7,9.0]), dementia (7.8%; 95% CI [7.7,7.9]), subsequent MI (7.1%; 95% CI [7.0,7.2]), and peripheral arterial disease (6.5%; 95% CI [6.4,6.6]). Compared with a risk-set matched population of 2,001,310 individuals, first hospitalisation of all non-fatal health outcomes were increased after MI, except for dementia (adjusted hazard ratio [aHR] 1.01; 95% CI [0.99,1.02];p = 0.468) and cancer (aHR 0.56; 95% CI [0.56,0.57];p < 0.001).
The study includes data from secondary care only—as such diagnoses made outside of secondary care may have been missed leading to the potential underestimation of the total burden of disease following MI.
Conclusions
In this study, up to a third of patients with MI developed heart failure or renal failure, 7% had another MI, and 38% died within 9 years (compared with 35% deaths among matched individuals). The incidence of all health outcomes, except dementia and cancer, was higher than expected during the normal life course without MI following adjustment for age, sex, year, and socioeconomic deprivation. Efforts targeted to prevent or limit the accrual of chronic, multisystem disease states following MI are needed and should be guided by the demographic-specific risk charts derived in this study.
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