Ten-year incidence and prognostic impact of new-onset heart failure after acute coronary syndromes: a population-based study (BEAT-HF)

Abstract

Introduction and objectives: Incident heart failure (iHF) impacts the downstream cardiovascular disease continuum, particularly after acute coronary syndromes (ACS). The aim of this study was to assess iHF after ACS from a population-based perspective, identify its risk factors, and analyze the associated clinical and resource burden.

Methods: Retrospective, population-based study including all individuals covered by the Catalonian public health care system, who were discharged after an ACS between January 1, 2011 and December 31, 2021. Integrated health care databases from multiple sources were used.

Results: Among 83 357 patients without previous HF who were discharged after ACS, 23.3% developed iHF during follow-up. The main risk factors for developing iHF after ACS included age (sHR, per year 1.03; 95%CI, 1.03-1.04), very low income (sHR, 2.08; 95%CI, 1.56-2.78), and Killip class II-III at presentation (sHR, 2.16; 95%CI, 2.06-2.27). Compared with patients without iHF, those who developed iHF had markedly higher rates of all-cause mortality (3.44-fold), major adverse cardiac events (2.75-fold), and substantially greater health care expenditure, mainly driven by hospitalizations.

Conclusions: One in 4 ACS survivors developed HF within 10 years, with major consequences for survival, morbidity, and health care costs. Socioeconomic status emerged as a determinant comparable to traditional clinical risk factors, suggesting the importance of targeted strategies to improve early identification and prevention of HF after ACS, particularly in socioeconomically vulnerable populations. Registered at ClinicalTrials.gov (NCT06255418).

Keywords: Acute coronary syndrome; Incident heart failure; Income level; Insuficiencia cardiaca incidente; Nivel socioeconómico; Síndrome coronario agudo.