Risk stratification in patients who develop heart failure after acute myocardial infarction remains challenging. The AHEAD score, comprising atrial fibrillation, hemoglobin level, elderly age, abnormal renal function, and diabetes, has previously demonstrated prognostic value in acute HF. However, its performance in the specific population with HF following AMI has not been fully clarified. Systemic inflammation contributes to adverse remodeling and outcomes after AMI. A study published in Scientific Reports evaluated whether incorporating the neutrophil-to-lymphocyte ratio (NLR) could improve prognostic assessment.

The study included 840 patients with HF after AMI (mean age 62.55 ± 11.89 years; 81.9% men). The median follow-up duration was 954 days. Cox proportional hazards regression assessed the association between the AHEAD score and all-cause mortality. The predictive performance of a modified model integrating NLR into the AHEAD score (AHEAD-NLR) was also evaluated.

The mean AHEAD score in the cohort was 1.05 ± 1.04. After adjustment for age, sex, red cell distribution width, uric acid, serum potassium, D-dimer, NLR, and left ventricular ejection fraction, the AHEAD score remained significantly associated with all-cause mortality (hazard ratio 1.27; 95% CI 1.019–1.582). A modified AHEAD-NLR score incorporating NLR ≥8.16 demonstrated improved predictive performance, with a net reclassification improvement of 19.9% for predicting all-cause mortality.

The AHEAD score was independently associated with mortality in patients with HF after AMI. Incorporation of an inflammatory marker into the model was associated with better risk classification in this population.