Heart 96:1458-1462 doi:10.1136/hrt.2009.191742
  • Heart failure

Unrecognised myocardial infarction and long-term risk of heart failure in the elderly: the Rotterdam Study

Editor's Choice
  1. Jacqueline C M Witteman1
  1. 1Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
  2. 2Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
  3. 3Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
  4. 4Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr Jacqueline C M Witteman, Department of Epidemiology, Erasmus MC, P O Box 2040, 3000 CA Rotterdam, The Netherlands; j.witteman{at}
  • Accepted 6 April 2010
  • Published Online First 18 May 2010


Objective To examine the association between unrecognised myocardial infarction (MI) as detected by electrocardiography and the long-term risk of heart failure.

Design The Rotterdam Study is a prospective population-based cohort study of the general population of a suburb of the city of Rotterdam, The Netherlands.

Participants At baseline 2581 men and 3724 women aged ≥55 years were classified on the basis of electrocardiography, interview and clinical data into those with recognised MI, those with ECG-based unrecognised MI and those without MI. The participants were followed-up for incident heart failure, death or end of the study period on 12 October 2006.

Results During a median follow-up time of 13.2 years, 823 cases of heart failure occurred, of which 403 in men. Independently of cardiovascular risk factors, recognised and unrecognised MIs yielded HRs of developing heart failure in men of 2.6 (95% CI 2.0 to 3.3) and 2.1 (95% CI 1.5 to 2.9), respectively. In women, recognised MI was associated with heart failure (HR=2.8; 95% CI 1.9 to 4.1), whereas unrecognised MI was not significantly related to the risk of heart failure (HR=1.1; 95% CI 0.7 to 1.7).

Conclusion Unrecognised MI detected by electrocardiography yields a long-term risk of heart failure equivalent to recognised MI in men, but is not significantly related to heart failure in women. In the light of the high incidence of both unrecognised MI and heart failure in the elderly, it may be worthwhile for both doctors and patients to improve responsiveness to typical and atypical symptoms of MI.


  • Funding This study is supported by The Netherlands Organisation for Scientific Research (NWO) [VICI 918-76-619]. The Rotterdam Study is supported by Erasmus MC; Erasmus University Rotterdam; Netherlands Organization for Health Research and Development (ZonMw);the Research Institute for Diseases in the Elderly (RIDE); the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sports; the European Commission; and the Municipality of Rotterdam.

  • Competing interests None.

  • Patient consent Participants provided written informed consent to participate in the Rotterdam Study and to obtain information from treating doctors.

  • Ethics approval The study was approved by the medical ethics committee of the Erasmus MC, Rotterdam, The Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Accepted 6 April 2010
  • Published Online First 18 May 2010