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August 31, 2022

Evaluating the Application of Chronic Heart Failure Therapies and Developing Treatments in Individuals With Recent Myocardial Infarction: A Review

Author Affiliations
  • 1Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina
  • 2Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
  • 3Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
  • 4Department of Cardiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
  • 5Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
  • 6Berlin Institute of Health Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany
  • 7German Centre for Cardiovascular Research partner site Berlin, Berlin, Germany
  • 8Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 9Women’s College Hospital and Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
  • 10Baylor Scott and White Research Institute, Dallas, Texas
  • 11Department of Medicine, University of Mississippi, Jackson
JAMA Cardiol. 2022;7(10):1067-1075. doi:10.1001/jamacardio.2022.2847

Importance  Despite advances in cardiac care, patients remain at a high risk of death and the development of heart failure (HF) following myocardial infarction (MI). These risks are highest in patients with reduced ejection fraction (EF) or signs of HF immediately after MI. Drugs to mitigate these risks have been identified through the systematic evaluation of therapies with proven efficacy in patients with HF and reduced EF (HFrEF).

Observations  Although landmark studies in patients with HFrEF consistently exclude patients with recent MI, dedicated post-MI trials of these drugs have led to multiple therapies with proven benefit in these patients. However, not all therapies with proven efficacy in patients with chronic HF have been shown to provide benefit in the post-MI population, as recently evidenced by the discrepant results between chronic HF and post-MI trials of sacubitril-valsartan. Similarly, multiple trials of early and aggressive use of therapies effective in chronic heart failure immediately post-MI failed to demonstrate benefit or were associated with harm, emphasizing the vulnerability of the post-MI population.

Conclusions and Relevance  Trials of patients at high risk of HF following MI have emphasized the differences between the post-MI and HFrEF populations and the necessity for dedicated trials in the post-MI population. This review summarizes trials studying the use of these therapies for at-risk patients following MI from therapies used in patients with HFrEF and exploring new potential therapies for this high-risk population.

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