Risk of Post-Heart Attack Death Has Declined Over 30 Years

But the risk continues to be high in heart attack patients who have congestive heart failure

TUESDAY, Nov. 4 (HealthDay News) -- In a Minnesota community practice, the overall risk of sudden cardiac death after a heart attack has significantly declined during the past 30 years but is still elevated in patients with heart failure, according to a report published in the Nov. 5 issue of the Journal of the American Medical Association.

A. Selcuk Adabag, M.D., of the Veterans Affairs Medical Center in Minneapolis, and colleagues conducted a population-based surveillance study of 2,997 Olmsted County residents who experienced a heart attack between 1979 and 2005 and were followed through February 2008. Among these patients, 842 had recurrent ischemia, 365 had heart failure, and 873 had both.

The researchers found that the 30-day cumulative incidence of sudden cardiac death of 1.2 percent was four times higher than expected (standardized mortality ratio, 4.2). But they found that the risk of sudden cardiac death was lower in 1997-2005 compared to 1979-1987 (hazard ratio, 0.62). After adjustment for baseline characteristics, the investigators found that heart failure was strongly associated with sudden cardiac death (HR, 4.20) but that recurrent ischemia was not (HR, 1.26).

"This underscores the importance of continued surveillance of patients after myocardial infarction and the dynamic nature of risk stratification," the authors conclude. "Moreover, the risk of sudden cardiac death after myocardial infarction has declined substantially over the past quarter of a century before the widespread use of defibrillators, which underscores the importance of evidence-based therapy for acute myocardial infarction including reperfusion and secondary prevention."

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