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Background  Heart failure ( HF ) is a serious complication of acute myocardial infarction ( AMI ). We explored the excess mortality associated with  HF  as an early or late complication of  AMI  and describe changes over time in such excess mortality.    Methods and Results  All patients hospitalized with an incident  AMI  and without history of prior  HF  hospitalization were followed up to 1 year after  AMI  discharge for episodes of  HF . New  HF  episodes were classified as  in‐hospital  HF   if diagnosed during the  AMI  hospitalization or  postdischarge  HF   if diagnosed within 1 year after discharge from the incident  AMI . Logistic and Cox regression models were used to explore the excess mortality associated with  HF  categories. Changes over time in the excess mortality were assessed by testing the interaction between  HF  status and study year. In‐hospital  HF  increased in‐hospital mortality 1.79 times (odds ratio [OR], 1.79; 95%  CI : 1.68–1.91). The excess mortality associated with  HF  increased by 4.3 times from 2001 to 2009 ( P  interaction<0.001) as a consequence of a greater decline of in‐hospital mortality among  AMI  patients without (9% per year) compared to those with in‐hospital  HF  (3% per year). Postdischarge  HF  increased all‐cause and  CVD  mortality 5.98 times (hazard ratio, 5.98; 95%  CI : 5.39–6.64) and 7.93 times (subhazard ratio, 7.93; 95%  CI : 6.84 –9.19), respectively. The relative excess 1‐year mortality associated with  HF  did not change significantly over time.    Conclusions  Development of  HF —either as an early or late complication of  AMI —has a negative impact on patients' survival. Changes in the excess mortality associated with  HF  are driven by modest improvements in survival among  AMI  patients with  HF  as compared to those without  HF .

journal of the american heart association

Prognostic Impact of In‐Hospital and Postdischarge Heart Failure in Patients With Acute Myocardial Infarction: A Nationwide Analysis Using Data From the  Cardiovascular Disease in Norway (CVDNOR)  Project