Post myocardial infarction – how to prevent, diagnose, and treat heart failure

With Liemena Harold Adrian, Syarifah Ambami Rato Ebu General Academic Hospital, Surabaya - Indonesia and Shelley Zieroth, St. Boniface Hospital, Winnipeg - Canada. 

In this episode, Liemena Harold Adrian and Shelley Zieroth discuss heart failure in post–myocardial infarction patients, covering how myocardial infarction leads to the development of heart failure despite advances in reperfusion and acute care. The conversation addresses the epidemiology and underlying pathophysiology, approaches to early prevention and screening, diagnostic tools, as well as key interventions in the acute and early post-MI phases that may alter heart failure trajectories. They outline management with guideline-directed medical therapy, review current studies on heart failure–modifying therapies (such as the DAPA-MI and EMPACT-MI trials), and address indications for advanced therapies in post-MI populations. The episode also highlights the importance of early diagnosis, prompt recognition, and key evidence gaps in the field.

Recommended readings:

• Akhtar KH, Khan MS, Baron SJ, et al. The Spectrum of Post-Myocardial Infarction Care: From Acute Ischemia to Heart Failurehttps://doi.org/10.1016/j.pcad.2024.01.017. Prog Cardiovasc Dis. (2024); 82: 15-25. DOI: 10.1016/j.pcad.2024.01.017.
• Butler J, Hammonds K, Talha KM, et al. Incident Heart Failure and Recurrent Coronary Events Following Acute Myocardial Infarctionhttps://doi.org/10.1093/eurheartj/ehae885. Eur Heart J (2025); 46: 1540-50. DOI: 10.1093/eurheartj/ehae885.
• Butler J, Jones WS, Udell JA. Empagliflozin after Acute Myocardial Infarction. N Engl J Med (2024); 390: 1455-66. DOI: 10.1056/NEJMoa2314051.
• Fioretti F, Butler J, Udell JA, et al. Empagliflozin after myocardial infarction with or without diabetes and chronic kidney disease: Insights from EMPACT-MI. ESC Heart Failure (2025); 12: 3940-3952. DOI: 10.1002/ehf2.15393.
• Hernandez AF, Udell JA, Jones WS. Effect of Empagliflozin on Heart Failure Outcomes After Acute Myocardial Infarction: Insights From the EMPACT-MI Trial. Circulation (2024); 149: 1627–1638. DOI: 10.1161/CIRCULATIONAHA.124.069217.
• Jenca D, Melenovsky V, Stehlik J, et al. Heart Failure after Myocardial Infarction: Incidence and Predictors. ESC Heart Failure (2021): 8: 222-237. DOI: 10.1002/ehf2.13144.
• Lala A, Beavers C, Blumer V, et al. The Continuum of Prevention and Heart Failure in Cardiovascular Medicine: A Joint Scientific Statement from the Heart Failure Society of America and The American Society for Preventive Cardiology. Journal of Cardiac Failure (2026); 32: 75-105.
• Petrie MC, Udell JA, Anker SD, et al. Empagliflozin in Acute Myocardial Infarction in Patients with and without Type 2 Diabetes: A Pre-specified Analysis of the EMPACT-MI Trial. Eur J of Heart Fail. (2025): 27: 577-588. DOI: 10.1002/ejhf.3548.
• Zieroth S, Rizi SS. Time Is of the Essence. JACC: Heart Failure (2023): 11(6): 713-714. DOI: 10.1016/j.jchf.2023.03.022

"This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsors."