Acute Decompensated Heart Failure in the Setting of Acute Coronary Syndrome

Highlights

• Acute decompensated heart failure in the setting of ACS is widely prevalent and associated with increased risk of both short- and long-term morbidity and mortality

• Recent neutral findings for use of ARNI after MI underscore the need for dedicated trials exploring the efficacy of new GDMT therapies in the post-MI population

• Future work is needed to improve implementation of existing therapies, and to identify new therapies for this high-risk group

Abstract

Acute coronary syndrome (ACS) is frequently complicated by evidence of heart failure (HF). Those at highest risk for acute decompensated HF in the setting of ACS (ACS-HF) are older, female, and have preexisting heart disease, type 2 diabetes mellitus, hypertension, and/or kidney disease. The presence of ACS-HF is strongly associated with higher mortality and more frequent readmissions, especially for HF. Low implementation of guideline-directed medical therapy has further complicated the clinical care of this high-risk population. Improved utilization of current therapies, coupled with further investigation of strategies to manage ACS-HF, is desperately needed to improve outcomes in this vulnerable population, and the results of currently ongoing or recently concluded ACS-HF studies in this population are of great interest. In this review, we explore the pathophysiology, epidemiology, risk factors, and outcomes for patients with ACS-HF, and describe both existing evidence for management of this challenging condition and areas requiring further research.