Heart failure is a common complication after acute myocardial infarction in patients with diabetes: A nationwide study in the SWEDEHEART registry

Background Several glucose lowering drugs with preventive effects on heart failure and death have entered the market, however, still used in low proportions after acute myocardial infarction. We explored the complication rates of heart failure and death after acute myocardial infarction in patients with and without diabetes. Methods All patients (N = 73,959) with acute myocardial infarction admitted for coronary angiography included in the SWEDEHEART registry during the years 2012-2017 were followed for heart failure (until 31 December 2017) and mortality (until 30 June 2018); mean follow-up time 1223 (SD +/- 623) days. Results Mean age was 69 years (SD +/- 12), 69% were male and 24% had diabetes. Heart failure occurred more often in diabetes (22% vs. 12% if no diabetes), especially if previous MI (33% vs. 23%). Patients with diabetes had increased risk of HF regardless of previous myocardial infarction (MI); with previous MI adjusted hazard ratio 2.09 (95% confidence interval 1.96-2.20) and without MI 1.52 (1.44-1.61) respectively when non-diabetes patients with first MI served as reference. In patients with no previous heart failure or MI and discharged with left ventricular ejection fraction >= 50% the risk of heart failure was particularly high in those with diabetes (1.56; 1.39-1.76) when compared with those without. Similar findings were seen for death and combined event (heart failure and death). Conclusions Heart failure is a common complication after acute myocardial infarction in diabetes, increasing the risk by 50-60% regardless of previous heart failure or MI. This risk is present even with normal reported left ventricular ejection fraction, indicating the existence of a large diabetes population at heart failure risk after acute myocardial infarction.