Heart Failure Management in Myocardial Infarction

Myocardial infarction triggers a cascade of myocardial injury, neurohormonal activation and structural remodelling that can culminate in clinical heart failure. Prompt reperfusion and optimal secondary prevention have transformed outcomes, yet a substantial proportion of survivors—often 20–30% within four years—will develop heart failure. Contemporary management rests on early initiation of neurohormonal blockade, meticulous volume and blood‐pressure control, and risk stratification using biomarkers and advanced imaging. Pharmacological pillars include β-blockers, renin–angiotensin–aldosterone system inhibitors, mineralocorticoid receptor antagonists, angiotensin receptor–neprilysin inhibitors and sodium–glucose cotransporter-2 inhibitors. Device therapy and remote monitoring further reduce hospitalisation. Emerging strategies aim to limit infarct size, prevent adverse remodelling and personalise therapy according to genetic, imaging and circulating‐biomarker profiles. Globally, integrated systems of acute care, long-term follow-up and rehabilitation are critical to reduce the burden of post-infarction heart failure.

Research from Nature Portfolio

Recent investigations in patients undergoing acute myocardial infarction with in-hospital coronary revascularisation have reaffirmed the benefit of early neurohormonal blockade. β-blockers initiated post-revascularisation were associated with lower major adverse cardiovascular events and reduced mortality at one year, while angiotensin‐converting enzyme inhibitors or receptor blockers decreased both all-cause mortality and heart failure hospitalisations. Notably, combined β-blocker and renin–angiotensin system inhibitor therapy yielded the most pronounced reductions in death and heart failure admissions, an effect consistent across preserved and reduced ejection‐fraction subgroups. These findings support guideline-recommended early initiation and combination of key pharmacological agents in contemporary practice.

Heart Failure Management in Myocardial Infarction publication trend

The graph below shows the total number of articles in heart failure management in myocardial infarction across all publications each year (not limited to Nature Index journals).

Technical terms

Neurohormonal inhibition: blockade of the sympathetic nervous system and renin–angiotensin–aldosterone system to prevent adverse cardiac remodelling.

Adverse remodelling: maladaptive changes in myocardial structure and geometry following injury that impair contractile function.

Neprilysin inhibitor: drug that prevents breakdown of natriuretic peptides, enhancing vasodilation and natriuresis, often combined with angiotensin receptor blockade.

SGLT2 inhibitor: sodium–glucose cotransporter-2 blocker that reduces heart failure risk by modulating renal sodium excretion and myocardial metabolism.

Left ventricular ejection fraction (LVEF): percentage of blood ejected from the left ventricle each beat, a core measure of systolic function.

References

1. Where Are We With Treatment and Prevention of Heart Failure in Patients Post–Myocardial Infarction?. JACC Heart Failure (2024).
2. Updates on the Renin–Angiotensin–Aldosterone System and the Cardiovascular Continuum. Biomedicines (2024).
3. Declining risk of heart failure hospitalization following first acute myocardial infarction in Scotland between 1991–2016. European Journal of Heart Failure (2023).
4. Beta-blockers and renin-angiotensin system inhibitors in acute myocardial infarction managed with inhospital coronary revascularization. Scientific Reports (2020).
5. Remote Postdischarge Treatment of Patients With Acute Myocardial Infarction by Allied Health Care Practitioners vs Standard Care. JAMA Cardiology (2021).