Underrecognition of Heart Failure After Acute Myocardial Infarction and Its Impact on Pharmacotherapy and Outcomes

OBJECTIVES

Heart failure (HF) following acute myocardial infarction (AMI) is a common and prognostically significant, yet the extent of HF underrecognition and its impact on guideline-directed medical therapy (GDMT) and clinical outcomes remain poorly characterised. We aimed to evaluate HF underrecognition prevalence among post-AMI patients meeting clinical HF criteria, and assess its association with GDMT prescribing patterns and 1-year all-cause mortality

MATERIALS AND METHODS

This single-centre retrospective cohort study included patients hospitalised for AMI at Seoul National University Hospital (2019–2023). Clinical HF was defined as left ventricular ejection fraction ≤40% with elevated natriuretic peptides. Patients were classified into recognised and underrecognised HF groups based on HF diagnostic codes. GDMT prescribing was evaluated at discharge and during 12 months of follow-up. One-year mortality was assessed using Cox regression with a 28-day landmark. 

RESULTS

Among 1,575 eligible patients, 167 (10.6%) met clinical HF criteria, of whom 52.7% were underrecognised. GDMT at discharge was suboptimal overall (29.3% receiving ≥3 classes; mean adequacy score 3.0 ± 2.3) without significant between-group difference. During follow-up, renin-angiotensin system inhibitor prescriptions increased in the recognised group but declined in the underrecognised group (12-month p=0.022). HF recognition (aHR=0.34, p=0.020) and GDMT adequacy score (aHR=0.77 per point, p=0.023) were each independently associated with lower mortality. 

CONCLUSION

More than half of post-AMI patients meeting clinical HF criteria were not formally recognised. Both HF recognition and GDMT adequacy were independently associated with improved survival, underscoring the need for systematic HF identification and pharmacotherapy optimisation.