Heart failure after myocardial infarction: Glass emptier than full

Abstract

Heart failure (HF) is an ominous and common complication following an acute myocardial infarction (MI). In fact, there is no single greater predictor of mortality following an MI than acute symptoms of HF.1 Once the acute period surrounding an MI is past, the risk continues, and an estimated 12–15% of all patients experiencing an MI will develop HF requiring hospitalization within a year. This risk appears to be especially high for patients who are older, female, who have reduced ejection fraction or acute congestion at the time of MI, and/or in those with certain comorbidities such as type 2 diabetes or chronic kidney disease.1 Once patients develop HF following an MI, their risk of death is markedly elevated. The risk of death associated with HF is substantially higher than the risk of death associated with a recurrent MI.2 As a result, a number of drugs with demonstrated risk reduction in death and/or HF hospitalization are routinely used as guideline-directed medical therapy (GDMT) in high-risk patients following an MI, including beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and mineralocorticoid receptor antagonists.3 It has been two decades since a post-MI drug trial identified a therapy that could reduce the risk for HF.3 Despite this, there are reasons to be hopeful that medical care for this population has improved, with regional efforts to improve acute coronary syndrome care management and activation of catheterization laboratories, new trials in antiplatelet therapies, and improved implementation of GDMT in this population, all of which may all contribute to improvements in outcomes for these patients.1,4 Given the high morbidity and mortality associated with HF after an MI, it is important to understand the contemporary demographic and clinical profile of these high-risk patients in order to provide best care, and to inform future trials investigating potential therapies for this vulnerable population. We therefore read with great interest the paper by Docherty et al.5 exploring trends in HF hospitalization after a first-time acute