Prevention of heart failure after acute myocardial infarction.

Abstract

This Series paper highlights the substantial progress made in understanding and preventing heart failure after acute myocardial infarction. Improving global standards of care for management of acute myocardial infarction with timelier reperfusion has led to stepwise reductions in risk of incident heart failure. Landmark clinical trials have established the role of renin-angiotensin-aldosterone system inhibitors, β blockers, and mineralocorticoid receptor antagonists to specifically reduce the risk of incident heart failure after acute myocardial infarction. However, residual risk of heart failure persists in many individuals, even after revascularisation and standard medical therapies. We review recent epidemiological trends from the past four decades, evolving understanding of the pathological mechanisms underlying incident heart failure, and modern risk stratification tools. We then propose a treatment pathway tailored to individual patient risk and discuss potential future strategies to incrementally improve the risk of development of heart failure after acute myocardial infarction.