European Journal of Heart Failure最新文献

Aims: Dipstick urine testing is often performed in primary and secondary care, although the results may not be routinely inspected or acted upon. We aimed to examine the prognostic value of semiquantitative urine dipstick proteinuria (DP) assessments in patients with heart failure (HF) and reduced ejection fraction.

Methods: This retrospective analysis utilized data from GALACTIC-HF, a randomized trial that investigated the efficacy and safety of the cardiac myosin activator, omecamtiv mecarbil, compared with placebo in patients with HF with reduced ejection fraction. The primary outcome was the composite of a first HF event (hospitalization or urgent visit for HF) or cardiovascular death, and secondary outcomes were a HF event, cardiovascular death, and all-cause death. Cox proportional hazard models were used to examine the relationship between DP levels and clinical outcomes.

Results: Baseline DP data were available for 7790 patients, of whom 5910 (75.9%) had a negative test or trace proteinuria, 995 (12.8%) had 1+, and 885 (11.4%) had ≥2+ proteinuria. The incidence rate of the primary outcome (per 100 person-years) increased significantly with increasing DP: negative/trace (21.8, 95% confidence interval 20.8-22.7); 1+ (34.8, 31.8-38.0); and ≥2+ (38.1, 34.7-41.9). Similar trends were observed for the components of the primary outcome and all-cause mortality. The association between greater DP and worse outcomes was stronger in patients with preserved (≥60 ml/min/1.73 m2) estimated glomerular filtration rate compared with reduced estimated glomerular filtration rate (<60 ml/min/1.73 m2).

Conclusion: In GALACTIC-HF, higher DP levels were independently associated with increased risk of adverse clinical outcomes in patients with reduced ejection fraction.

Trial registration: GALACTIC-HF ClinicalTrials.gov Identifier: NCT02929329; EudraCT number, 2016-002299-28.

There is strong evidence that hypertension is a major risk factor for heart failure (HF). Hypertension contributes to incident HF through direct and indirect effects. Indirect effects are consequences of ischaemic heart disease because hypertension facilitates atherosclerotic obstructive coronary artery disease. The direct effects are straightly related to hypertensive heart disease (HHD). Hypertensive heart disease poses a significant challenge with substantial medical and public health implications. Efforts should be made to recognize and manage HHD in a timely manner and optimize hypertension treatment. Reducing blood pressure (BP) and/or reassessing antihypertensive therapy using traditional or novel approaches can halt or delay progression to HF in patients with HHD and possibly prevent it. However, HHD's importance as a risk factor for overt HF is often overlooked in clinical practice. This document aims to summarize the current understanding of the burden of HHD and its risk for incident HF, discuss the mechanisms underlying HHD-related HF onset and progression, consider how diagnostic tools contribute to individualized phenotyping and HF risk stratification of HHD, address how therapeutic measures ameliorating or even preventing structural and functional alterations of HHD, along with BP control influence HHD-associated HF risk.

Aims: In patients with heart failure (HF) influenza vaccination has shown beneficial effects in preventing cardiac decompensations. However, no conclusive results have been achieved in the few studies that have evaluated the impact of vaccination during episodes of acute HF (AHF) decompensation. We conducted a systematic review and meta-analysis to determine the possible effects of influenza vaccination on all-cause mortality in patients diagnosed with AHF.

Methods: PubMed, Medline, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews databases were searched for longitudinal studies comparing patients with AHF vaccinated against influenza with unvaccinated patients. The primary outcome selected for meta-analysis was 1-year all-cause mortality, and secondary outcomes consisted of other outcomes reported in at least in two different studies. Statistical heterogeneity was determined by calculating the I² statistic. Individual adjusted results were pooled using a random effects model. Sensitivity analysis was run for the primary outcome by removing each individual study and then re-doing the meta-analysis.

Results: Up to 30 June 2025, five observational cohort studies examining the effect of influenza vaccination on 1-year all-cause mortality in AHF patients had been published. Statistical heterogeneity was low (I2 = 33.7%), meaning that between-study results were consistent. Pooled analysis of confounder-adjusted hazard ratio (HR) for all-cause mortality in vaccinated patients was 0.89 (95% CI 0.83-0.96) compared with unvaccinated patients. All sensitivity analyses rendered very similar results. In-hospital and 90-day mortality were reported in three and two studies and showed similar reductions in risk, with an adjusted odds ratio of 0.85, 95% CI 0.70-1.01, and adjusted HR of 0.86, 95% CI 0.76-0.96; respectively. Isolated data from single studies suggest no effect on hospitalization following discharge after the AHF episode.

Conclusions: Influenza vaccination is associated with a lower short- and long-term all-cause mortality in patients with decompensated HF; however, as all the studies included in this meta-analysis were observational, these results could be subject to residual confounding and causality cannot be directly inferred from them.

Aims: For many years, fluid and sodium restriction have been considered an essential strategy for achieving effective decongestion in acute heart failure (AHF), but this paradigm has recently been questioned. This analysis aims to evaluate and compare the effectiveness of three different fluid strategies for decongestion: no fluid, fluid with sodium/chloride, and fluid without sodium/chloride in AHF.

Methods: This post-hoc analysis of two prospective, single-centre, mechanistic studies included 55 patients with AHF and fluid overload. All patients received standardized furosemide dosing. A total of 21 patients received a continuous infusion of 0.9% NaCl (83 mL/h), 19 patients received 5% glucose (83 mL/h), and 15 did not receive any fluids. The primary outcome is urine volume and natriuresis at 6 h after loop diuretic administration.

Results: There was a significant difference in cumulative (6 h) net natriuresis between patients receiving fluid therapy (n = 40) and those without fluid therapy (n = 15) (139 [66-264] mmol vs. 79 [15-144] mmol, P = .043). There was no significant difference in cumulative net diuresis between these groups (1170 [880-1890] mL vs. 1010 [475-1270] mL, P = .078), respectively. The NaCl group had a better diuretic response when compared with the glucose and no-fluids groups (absolute: 1980 [1620-3150] mL vs. 1510 [1075-2175] mL vs. 1010 [475-1270] mL, P < .001, net: 1480 [1120-2650] mL vs. 1010 [575-1675] mL vs. 1010 [475-1270] mL, P = .019, respectively) but the difference in natriuresis did not meet statistical significance (P = .126).

Conclusion: Intravenous fluid replacement during decongestion in patients with AHF was associated with increased net natriuresis and a trend towards higher urine output, with a significant augmentation of diuresis with sodium chloride supplementation.

Introduction: Heart failure (HF) hospitalizations are frequent and lengthy, and usually involve treatment with intravenous diuretics to relieve congestion. SUBCUT HF II is evaluating the safety and efficacy of an alternative ambulatory care strategy using a novel subcutaneous formulation of furosemide delivered via a wearable pump.

Methods: The SUBCUT HF II trial is a multicentre, randomized, active comparator trial involving 20 hospitals in the UK. Eligible participants are patients with HF receiving inpatient treatment with intravenous loop diuretic. Patients are randomized to either early supported discharge, using a novel formulation of subcutaneous furosemide (SQIN-Furosemide) administered by a wearable pump (SQIN-Infusor), or continued inpatient treatment using intravenous furosemide.

Results: The primary endpoint is days spent alive and out of hospital at 30 days. As of October 2025, 168 of 170 patients have been randomized.

Conclusion: The SUBCUT HF II trial is testing the safety and efficacy of an ambulatory care approach to managing patients presenting to the hospital with HF.

Trial registration: ClinicalTrials.gov identifier NCT05419115.

Aims: Qiliqiangxin (QLQX), a Chinese traditional medicine, improved outcomes in patients with heart failure and reduced ejection fraction (HFrEF) when added to guideline-directed therapy. As treatment effects in heart failure (HF) may vary with left ventricular ejection fraction (LVEF), this post hoc analysis of the QUEST (Qiliqiangxin in Heart Failure: Assessment of Reduction in Mortality) trial examined whether baseline LVEF modified the efficacy and safety of QLQX.

Methods: QUEST randomized 3110 patients with symptomatic HF and LVEF ≤40%. The primary outcome was cardiovascular death or first HF hospitalization. Baseline LVEF was categorized as ≤25% (n = 482), >25-30% (n = 692), >30-35% (n = 829), and >35% (n = 1107).

Results: Mean LVEF was 32% (median 33%, interquartile range 28%-37%). Patients with LVEF ≤25% had the highest rate of the primary outcome (25.4 per 100 patient-years), while rates were similar across higher LVEF groups (18.7-19.8). After multivariable adjustment, lower LVEF was independently associated with higher risks of the primary outcome and mortality. The effect of QLQX on the primary outcome was consistent across LVEF categories (hazard ratio [95% CI] from the lowest to highest: 0.91 [0.64-1.30], 0.65 [0.47-0.89], 0.94 [0.71-1.26], and 0.71 [0.55-0.91], respectively; Pinteraction = .28), and as a continuous variable (Pinteraction = .45). Similar results were observed for individual components and total HF hospitalizations (all Pinteraction > .10). The safety of QLQX was also consistent across LVEF categories.

Conclusion: In patients with HFrEF, lower LVEF was associated with worse cardiovascular outcomes. QLQX reduced cardiovascular events consistently across the range of LVEF examined in QUEST, despite the limited use of sodium-glucose co-transporter 2 inhibitors.

Chictr registration: ChiCTR1900021929.