Heart failure raises death risk after heart attack

NEW YORK (Reuters Health) - While the rate of sudden death after a heart attack has markedly declined since the 1980s, the risk during the first 30 days after an attack is still four times higher than in the general population, new research shows. The findings suggest that this is mostly related to the presence of heart failure.

Current strategies for predicting sudden death after a heart attack use risk factors that are present at the time of the attack and don't take into account events that may occur later, such as heart failure, Dr. Veronique L. Roger and colleagues explain in the Journal of the American Medical Association.

Roger of the Mayo Clinic in Rochester, Minnesota, and colleagues studied the risk of sudden death among 2997 residents of Olmsted county who had a heart attack and survived to hospital discharge between 1979 and 2005. During follow-up through the end of February 2008, there were 282 sudden deaths.

The risk of sudden death following a heart attack declined significantly between 1997 and 2005 compared with the period between 1979 and 1987.

However, the death rate during the first 30 days remained high at 1.2 percent, roughly four times the rate seen in the general population. After 30 days, the risk was not increased.

The risk of heart failure in the 30 days after a heart attack was 26 percent. Further analysis showed that heart failure was associated with a 4.2-fold increased risk of sudden death.

These findings, Roger's group says, "underscore the importance of continued surveillance" of heart attack patients, and "the importance of evidence-based therapy" for these patients.

SOURCE: Journal of the American Medical Association, November 5, 2008.