Risk factors for myocardial infarction in patients with heart failure

Abstract Background Heart failure (HF) is affecting 1-2% of the adult population in western countries. HF is related to increased morbidity and mortality. Coronary artery disease is the most common cause of HF. The acute manifestation of coronary artery disease is myocardial infarction (MI) and it is of main interest to identify risk factors for this crucial event in patients admitted due to HF. Objective We aimed to identify risk factors of MI in patient who were hospitalized due to HF. Methods The nationwide German inpatient statistics (NIS) of the years 2005-2022 was used for this statistical analysis (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2022, and own calculations). Hospitalizations of patients, who were admitted due to HF in German hospitals, were stratified for MI and compared. Risk factors for MI were analysed. Results In total, 7,265,342 hospitalizations of patients admitted due to HF in Germany during the observational period 2005-2022 were included in our study; among these, 153,323 (2.1%) suffered from MI. HF patients with a MI event during hospitalization were more often of male sex (52.8% vs. 48.6%, P0.001), and had more often cardiovascular risk factors such as diabetes mellitus (43.3% vs. 38.6%, P0.001). Peripheral artery disease (9.3% vs. 6.1%, P0.001) as well as acute and chronic kidney disease (56.7% vs. 48.4%, P0.001) were more prevalent in HF patients with MI. Case-fatality was substantially higher in HF with than without MI (19.7% vs. 8.9%, P0.001). Age ≥70 years (OR 1.12 95%CI 1.10-1.13, P0.001), diabetes mellitus (OR 1.15 95%CI 1.14-1.17, P0.001), hyperlipidaemia (OR 1.29 95%CI 1.28-1.31, P0.001), peripheral artery disease (OR 1.39 95%CI 1.36-1.41, P0.001) as well as acute and chronic kidney disease (OR 1.35 95%CI 1.33-1.36, P0.001) were associated with an increased risk for occurrence of MI. Conclusion HF patients are afflicted by an increased risk for MI events. In Germany, more than 2% of the hospitalized HF patients developed an MI during in-hospital course. Independent risk factors for MI in HF patients were age ≥70 years, cardiovascular risk factors including diabetes and hyperlipidaemia, but also atherosclerotic vascular and renal diseases.