The risk of incident heart failure (HF) after a myocardial infarction (MI) is up to six-fold higher than the risk of recurrent MI and the prognosis is worse among those who develop incident HF, regardless of LVEF category, according to a study published Jan. 28 in the European Heart Journal.

Javed Butler, MBBS, FACC, et al., looked at contemporary trends in patient characteristics, risks and outcomes in post-MI patients to understand the development of incident HF and recurrent MI and identify clinical and research priorities. The study included 6,804 patients diagnosed with an MI and discharged from one of 28 hospitals in the Baylor Scott & White Health system in Texas from January 2015 to December 2021. Their median age was 69 years and about 60% were male. Most patients had hypertension (89%) and dyslipidemia (87%); 48% had type 2 diabetes and 34% had chronic kidney disease. Overall, 76.7% of patients had NSTEMI; 23.3% had a previous history of HF and 16.8% of MI. Most (63%) underwent percutaneous/surgical revascularization.

At the landmark-anchored one-year outcome analysis, 6.7% of patients had died, 27.9% had all-cause and 11.8% had cardiovascular rehospitalizations, and 3.8% had recurrent MI. Among MI patients without a history of HF, 23.8% developed incident HF within three months of discharge (LVEF <40%, 41-49% and >50% in 42.2%, 26.7% and 31.1%, respectively). Incident HF was defined as two or more separate encounters coded for HF if diagnosed during index admission or one or more encounter coded for HF in patients not diagnosed during index admission.

Notably, patients who developed HF had a higher risk of death and hospitalizations, regardless of LVEF (all p<0.001). Of 2,179 patients with LVEF >50% without prevalent HF or HF during index hospitalization, 11.8% developed HF and 3.5% had recurrent MI within one year.

The study findings highlight the high risk of developing HF post MI, even among those with a normal LVEF and no HF at discharge, and the significantly increased risks of all-cause mortality and hospitalizations.

The authors conclude that "these data underscore a need to better understand the mechanisms behind the development of HF post-MI, especially among those with normal LVEF, and to develop therapeutic strategies targeting the preservation of myocardial function and mitigating the risk of HF following MI."