Yogesh N V Reddy,Mary-Tiffany Oduah,Fadi Adel,William R Miranda,Ian Greenlund,Kent R Bailey,Jeffrey Testani,Virend K Somers,Barry A Borlaug,Naveen L Pereira
{"title":"Very High Dose Loop Diuretics for Worsening Heart Failure - A Randomized Pilot Trial.","authors":"Yogesh N V Reddy,Mary-Tiffany Oduah,Fadi Adel,William R Miranda,Ian Greenlund,Kent R Bailey,Jeffrey Testani,Virend K Somers,Barry A Borlaug,Naveen L Pereira","doi":"10.1093/ejhf/xuag069","DOIUrl":"https://doi.org/10.1093/ejhf/xuag069","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"7 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sebastiaan Dhont,Sara Moura-Ferreira,Youri Bekhuis,Maarten Falter,Mauricio Milani,Wouter L'Hoyes,Sarah Hoedemakers,Lucie Soens,Annemie Jacobs,Stephanie De Schutter,Rik Pauwels,Boris Delpire,Johan Verbeeck,Ruta Jasaityte,Jan Stassen,Lieven Herbots,Guido Claessen,Andreas B Gevaert,Philippe Debonnaire,Alexander Van De Bruaene,Frederik H Verbrugge,Philippe B Bertrand,Jan Verwerft
BACKGROUND AND AIMSIn patients with unexplained dyspnea, heart failure with preserved ejection fraction (HFpEF) is a frequent cause. Diagnostic scores estimate HFpEF probability, but their prognostic role and clinical applicability in this population remain uncertain. This study evaluated the association of HFpEF scores with structural remodeling, functional limitation, and clinical outcomes.METHODSThis multicenter cohort study included 2,535 patients with unexplained dyspnea who underwent combined cardiopulmonary exercise testing and echocardiography. HFpEF probability was assessed using H₂FPEF, HFA-PEFF, and HFpEF-ABA scores, with patients stratified into risk categories.RESULTSHigher scores correlated with adverse ventricular and atrial remodeling, impaired exercise capacity, and higher pulmonary pressures, both at rest and during exercise. Intermediate and high-risk categories for HFA-PEFF, H₂FPEF, and HFpEF-ABA scores showed significantly elevated hazard ratios versus the low-risk group: HFA-PEFF (HR 2.62 95%CI 1.56-4.40, p<0.001 and 5.49 95%CI 2.82-10.67, p=0.005), H₂FPEF (HR 2.74 95%CI 1.35-5.89, p<0.001 and 6.21 95%CI 2.86-13.5, p<0.001), and HFpEF-ABA (HR 1.28 95%CI 0.57-2.86, p=0.549 and 2.50 95%CI 1.02-6.14, p=0.046), all p<0.001. Event rates increased stepwise across score categories, reaching 10 per 100 patient-years in the high-score groups. Score performance differed, particularly in the elderly, women, and those with atrial fibrillation. Incorporating echocardiographic parameters, particularly resting pulmonary pressure, improved HFpEF-ABA prognostic accuracy. In the NT-proBNP subgroup, functional criteria and NT-proBNP remained independent predictors for outcome.CONCLUSIONSHFpEF diagnostic scores reflect the structural and functional disease burden as well as clinical risk in unexplained dyspnea. These scores are complementary and may enhance risk stratification.
{"title":"Comparative Value of HFpEF Scores for Risk Stratification in Patients with Unexplained Dyspnea.","authors":"Sebastiaan Dhont,Sara Moura-Ferreira,Youri Bekhuis,Maarten Falter,Mauricio Milani,Wouter L'Hoyes,Sarah Hoedemakers,Lucie Soens,Annemie Jacobs,Stephanie De Schutter,Rik Pauwels,Boris Delpire,Johan Verbeeck,Ruta Jasaityte,Jan Stassen,Lieven Herbots,Guido Claessen,Andreas B Gevaert,Philippe Debonnaire,Alexander Van De Bruaene,Frederik H Verbrugge,Philippe B Bertrand,Jan Verwerft","doi":"10.1093/ejhf/xuag072","DOIUrl":"https://doi.org/10.1093/ejhf/xuag072","url":null,"abstract":"BACKGROUND AND AIMSIn patients with unexplained dyspnea, heart failure with preserved ejection fraction (HFpEF) is a frequent cause. Diagnostic scores estimate HFpEF probability, but their prognostic role and clinical applicability in this population remain uncertain. This study evaluated the association of HFpEF scores with structural remodeling, functional limitation, and clinical outcomes.METHODSThis multicenter cohort study included 2,535 patients with unexplained dyspnea who underwent combined cardiopulmonary exercise testing and echocardiography. HFpEF probability was assessed using H₂FPEF, HFA-PEFF, and HFpEF-ABA scores, with patients stratified into risk categories.RESULTSHigher scores correlated with adverse ventricular and atrial remodeling, impaired exercise capacity, and higher pulmonary pressures, both at rest and during exercise. Intermediate and high-risk categories for HFA-PEFF, H₂FPEF, and HFpEF-ABA scores showed significantly elevated hazard ratios versus the low-risk group: HFA-PEFF (HR 2.62 95%CI 1.56-4.40, p<0.001 and 5.49 95%CI 2.82-10.67, p=0.005), H₂FPEF (HR 2.74 95%CI 1.35-5.89, p<0.001 and 6.21 95%CI 2.86-13.5, p<0.001), and HFpEF-ABA (HR 1.28 95%CI 0.57-2.86, p=0.549 and 2.50 95%CI 1.02-6.14, p=0.046), all p<0.001. Event rates increased stepwise across score categories, reaching 10 per 100 patient-years in the high-score groups. Score performance differed, particularly in the elderly, women, and those with atrial fibrillation. Incorporating echocardiographic parameters, particularly resting pulmonary pressure, improved HFpEF-ABA prognostic accuracy. In the NT-proBNP subgroup, functional criteria and NT-proBNP remained independent predictors for outcome.CONCLUSIONSHFpEF diagnostic scores reflect the structural and functional disease burden as well as clinical risk in unexplained dyspnea. These scores are complementary and may enhance risk stratification.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"10 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the Editor answering to Chai and Wang Beta-blockers in patients with heart failure with reduced ejection fraction and concomitant chronic obstructive pulmonary disease: cardiovascular and respiratory outcomes.","authors":"Benedikt N Beer,Felix Lindberg,Gianluigi Savarese","doi":"10.1093/ejhf/xuag066","DOIUrl":"https://doi.org/10.1093/ejhf/xuag066","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"37 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fardad Soltani,Nicholas Black,Joshua Bradley,Lucy Priestner,Naing Ko Ko,Hannah Glasse,Isabelle Milner,Sarah Kreppel,Matthias Schmitt,Gaetano Nucifora,Mark C Petrie,Abdallah Al-Mohammad,Gerry P McCann,R Thomas Lumbers,Janine Beezer,Maria F Paton,Shaun Robinson,Rebecca Hyland,Nick Hartshorne-Evans,Laurence Humphreys-Davies,Zahra Raisi-Estabragh,Steffen E Petersen,William G Newman,Theresa McDonagh,Jamil Mayet,Simon G Williams,David A Jenkins,Andrew P Morris,Niels Peek,Christopher A Miller
AIMSHeart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome commonly hypothesised to comprise discrete subtypes. This study aimed to characterise HFpEF heterogeneity using advanced data science techniques applied to deeply phenotyped, multi-modal cohorts.METHODS AND RESULTS902 patients with HF and a left ventricular ejection fraction ≥ 50% were prospectively recruited and underwent detailed clinical, imaging, and genetic profiling. Clustering algorithms were first applied to derive discrete subgroups. To overcome rigid subgroup assignment, DDRTree was applied to map continuous phenotypic and outcome variation onto a two-dimensional tree. Genome-wide association studies (GWAS) identified variants associated with tree dimensions. Internal validation assessed stability, and external validation was conducted in a UK Biobank HFpEF cohort (n=148). Sensitivity analyses included patients with mildly reduced ejection fraction (n=1154). Logistic regression compared HFpEF with comorbidity-matched controls (n=902). Whilst conventional clustering did not identify meaningful subgroups, DDRTree revealed a stable, interpretable tree structure, capturing continuous variation in cardiac structure and function, biomarkers and comorbidities. Over a median follow-up of 6.8 years, phenotypic complexes demonstrated differing risks of cardiovascular death, HF hospitalisation, adverse renal outcome, and infection hospitalisation. GWAS revealed a locus near CRACD associated with tree dimension one. Findings were reproducible in external and sensitivity analyses. A profile of cardiac and systemic characteristics that distinguish HFpEF from its associated comorbidities were identified.CONCLUSIONSHFpEF risk and disease course reflect a variable interplay of pathophysiological processes in each individual. This study provides a biologically plausible framework to guide a more personalised approach to HFpEF.
{"title":"Characterising the heterogeneity of heart failure with preserved ejection fraction: moving beyond subgroups and distinguishing disease from risk.","authors":"Fardad Soltani,Nicholas Black,Joshua Bradley,Lucy Priestner,Naing Ko Ko,Hannah Glasse,Isabelle Milner,Sarah Kreppel,Matthias Schmitt,Gaetano Nucifora,Mark C Petrie,Abdallah Al-Mohammad,Gerry P McCann,R Thomas Lumbers,Janine Beezer,Maria F Paton,Shaun Robinson,Rebecca Hyland,Nick Hartshorne-Evans,Laurence Humphreys-Davies,Zahra Raisi-Estabragh,Steffen E Petersen,William G Newman,Theresa McDonagh,Jamil Mayet,Simon G Williams,David A Jenkins,Andrew P Morris,Niels Peek,Christopher A Miller","doi":"10.1093/ejhf/xuag056","DOIUrl":"https://doi.org/10.1093/ejhf/xuag056","url":null,"abstract":"AIMSHeart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome commonly hypothesised to comprise discrete subtypes. This study aimed to characterise HFpEF heterogeneity using advanced data science techniques applied to deeply phenotyped, multi-modal cohorts.METHODS AND RESULTS902 patients with HF and a left ventricular ejection fraction ≥ 50% were prospectively recruited and underwent detailed clinical, imaging, and genetic profiling. Clustering algorithms were first applied to derive discrete subgroups. To overcome rigid subgroup assignment, DDRTree was applied to map continuous phenotypic and outcome variation onto a two-dimensional tree. Genome-wide association studies (GWAS) identified variants associated with tree dimensions. Internal validation assessed stability, and external validation was conducted in a UK Biobank HFpEF cohort (n=148). Sensitivity analyses included patients with mildly reduced ejection fraction (n=1154). Logistic regression compared HFpEF with comorbidity-matched controls (n=902). Whilst conventional clustering did not identify meaningful subgroups, DDRTree revealed a stable, interpretable tree structure, capturing continuous variation in cardiac structure and function, biomarkers and comorbidities. Over a median follow-up of 6.8 years, phenotypic complexes demonstrated differing risks of cardiovascular death, HF hospitalisation, adverse renal outcome, and infection hospitalisation. GWAS revealed a locus near CRACD associated with tree dimension one. Findings were reproducible in external and sensitivity analyses. A profile of cardiac and systemic characteristics that distinguish HFpEF from its associated comorbidities were identified.CONCLUSIONSHFpEF risk and disease course reflect a variable interplay of pathophysiological processes in each individual. This study provides a biologically plausible framework to guide a more personalised approach to HFpEF.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"198 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hawani Sasmaya Prameswari,Cindya Perthy Iswandi,Jordan Budiono,Melawati Hasan,Dian Yaniarti Hasanah,Triwedya Indra Dewi,Johann Bauersachs,Karen Sliwa Hahnle,Peter van der Meer
BACKGROUNDSubsequent pregnancy in women with prior peripartum cardiomyopathy (PPCM) carries a risk of relapse and adverse maternal outcomes. This meta-analysis aimed to determine the recurrence of PPCM relapse and associated maternal and fetal outcomes during subsequent pregnancy, stratified by baseline (pre-subsequent pregnancy) left ventricular ejection fraction (LVEF).METHODSA systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Nine databases were searched through June 2025 for cohort studies reporting subsequent pregnancy outcomes in women with prior PPCM, stratified as recovered (LVEF ≥50%) or non-recovered (LVEF <50%) groups. Outcomes included PPCM relapse, maternal mortality, LVEF during and after pregnancy, LV recovery, symptom worsening, and obstetric/neonatal events. Risk of bias was assessed with ROBINS-E, and random-effects models were used.RESULTSSix cohort studies comprising 266 women were included (174 in recovered group and 92 in non-recovered group). Relapse occurred in both groups with no significant difference (rate ratio [RR] 0.77, 95% CI 0.50-1.19; I2=3%). Maternal mortality was significantly lower in the recovered group (1.7% vs 10.9%; RR 0.27, 95% CI 0.09-0.87; I2=0%). Recovered group had higher mean LVEF during subsequent pregnancy (mean difference [MD] 17.0; p<0.001), higher postpartum LVEF (MD 11.69; p=0.005; I2=84%), and greater likelihood of LV recovery (RR 2.07; p=0.005; I2=0%). No significant differences were observed in symptom worsening or obstetric/neonatal outcomes.CONCLUSIONRecovered LVEF prior to subsequent pregnancy is associated with improved maternal outcomes, yet relapse remains common. LVEF alone is insufficient for risk stratification, and individualized multidisciplinary care is essential for all women with prior PPCM.
背景：有围产期心肌病（PPCM）的妇女再次怀孕有复发和不良产妇结局的风险。本荟萃分析旨在确定PPCM复发的复发率以及随后妊娠期间相关的母胎结局，以基线（妊娠前）左心室射血分数（LVEF）分层。方法按照PRISMA指南进行系统评价和荟萃分析。截至2025年6月，我们检索了9个数据库，纳入报道既往PPCM妇女后续妊娠结局的队列研究，分为恢复组（LVEF≥50%）和未恢复组（LVEF <50%）。结果包括PPCM复发、孕产妇死亡率、妊娠期间和妊娠后LVEF、LV恢复、症状恶化和产科/新生儿事件。采用ROBINS-E评估偏倚风险，并采用随机效应模型。结果共纳入6项队列研究266例，其中康复组174例，未康复组92例。两组患者的复发率差异无统计学意义（RR = 0.77, 95% CI = 0.50-1.19; I2=3%）。康复组的产妇死亡率显著降低（1.7% vs 10.9%; RR 0.27, 95% CI 0.09-0.87; I2=0%）。康复组在随后的妊娠期间平均LVEF较高（平均差值[MD] 17.0; p<0.001），产后LVEF较高（MD 11.69; p=0.005; I2=84%）， LV恢复的可能性较大（RR 2.07; p=0.005; I2=0%）。在症状恶化或产科/新生儿结局方面未观察到显著差异。结论妊娠前LVEF恢复与产妇预后改善相关，但复发仍很常见。单独的LVEF不足以进行风险分层，个体化的多学科护理对所有既往PPCM的妇女至关重要。
{"title":"Recurrence of Peripartum Cardiomyopathy in Subsequent Pregnancy Stratified by Left Ventricular Function: A Systematic Review and Meta-Analysis.","authors":"Hawani Sasmaya Prameswari,Cindya Perthy Iswandi,Jordan Budiono,Melawati Hasan,Dian Yaniarti Hasanah,Triwedya Indra Dewi,Johann Bauersachs,Karen Sliwa Hahnle,Peter van der Meer","doi":"10.1093/ejhf/xuag063","DOIUrl":"https://doi.org/10.1093/ejhf/xuag063","url":null,"abstract":"BACKGROUNDSubsequent pregnancy in women with prior peripartum cardiomyopathy (PPCM) carries a risk of relapse and adverse maternal outcomes. This meta-analysis aimed to determine the recurrence of PPCM relapse and associated maternal and fetal outcomes during subsequent pregnancy, stratified by baseline (pre-subsequent pregnancy) left ventricular ejection fraction (LVEF).METHODSA systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Nine databases were searched through June 2025 for cohort studies reporting subsequent pregnancy outcomes in women with prior PPCM, stratified as recovered (LVEF ≥50%) or non-recovered (LVEF <50%) groups. Outcomes included PPCM relapse, maternal mortality, LVEF during and after pregnancy, LV recovery, symptom worsening, and obstetric/neonatal events. Risk of bias was assessed with ROBINS-E, and random-effects models were used.RESULTSSix cohort studies comprising 266 women were included (174 in recovered group and 92 in non-recovered group). Relapse occurred in both groups with no significant difference (rate ratio [RR] 0.77, 95% CI 0.50-1.19; I2=3%). Maternal mortality was significantly lower in the recovered group (1.7% vs 10.9%; RR 0.27, 95% CI 0.09-0.87; I2=0%). Recovered group had higher mean LVEF during subsequent pregnancy (mean difference [MD] 17.0; p<0.001), higher postpartum LVEF (MD 11.69; p=0.005; I2=84%), and greater likelihood of LV recovery (RR 2.07; p=0.005; I2=0%). No significant differences were observed in symptom worsening or obstetric/neonatal outcomes.CONCLUSIONRecovered LVEF prior to subsequent pregnancy is associated with improved maternal outcomes, yet relapse remains common. LVEF alone is insufficient for risk stratification, and individualized multidisciplinary care is essential for all women with prior PPCM.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"82 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peder L Myhre,Felix Lindberg,Brian B Løgstrup,Inga J Ingimarsdottir,Maria Vistnes,Inge Schjødt,Charlotta Ljungman,Gianluigi Savarese,Nadia P Dridi,Hafsteinn Einarsson,Tomas Mellberg,Kristian Berge,Alexandre Mebazaa,Lars H Lund
This review evaluates the role of heart failure (HF) registries in the Nordic countries-Sweden, Denmark, Norway, and Iceland-in the implementation of the European Society of Cardiology's guidelines for guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF). It critically examines how these registries facilitate clinical practice and enhance patient outcomes through their design, data collection methods, and the evaluation of key metrics related to GDMT implementation over time. We highlight the nurse-led models adopted by these registries, which emphasize quality benchmarks and feature real-time feedback mechanisms regarding the application of GDMT. Between 2021 and 2024, registry population-weighted estimates revealed significant increases in the utilization of key therapies: mineralocorticoid receptor antagonists rose from 51% to 72%, sodium-glucose co-transporter-2 inhibitors from 20% to 81%, and sacubitril/valsartan from 22% to 32%. The use of beta-blockers and renin-angiotensin-system inhibitors remained consistently high at 91% and 94%, respectively. These shifts were linked to better treatment outcomes. The findings underscore that HF registries play a crucial role in enhancing care quality through established drug therapies for HFrEF, offering a model for integrating data-driven methodologies into HF management. Future utilization and expansion of these registries are vital for tackling healthcare disparities and refining treatment strategies for HF patients.
本综述评估了北欧国家（瑞典、丹麦、挪威和冰岛）心力衰竭（HF）登记在实施欧洲心脏病学会（European Society of Cardiology）的指南指导药物治疗（GDMT）心力衰竭并降低射血分数（HFrEF）方面的作用。它批判性地考察了这些注册如何通过其设计、数据收集方法和评估与GDMT实施相关的关键指标来促进临床实践并提高患者预后。我们重点介绍了这些注册中心采用的以护士为主导的模型，该模型强调了关于GDMT应用的质量基准和实时反馈机制。2021年至2024年间，登记人口加权估计显示关键疗法的使用率显著增加：矿皮质激素受体拮抗剂从51%上升到72%，钠-葡萄糖共转运蛋白-2抑制剂从20%上升到81%，苏比里尔/缬沙坦从22%上升到32%。受体阻滞剂和肾素-血管紧张素系统抑制剂的使用率分别保持在91%和94%的高位。这些转变与更好的治疗结果有关。研究结果强调，心衰登记在通过既定的HFrEF药物治疗提高护理质量方面发挥着至关重要的作用，为将数据驱动的方法整合到心衰管理中提供了一种模式。未来利用和扩大这些登记对于解决医疗保健差距和改进心衰患者的治疗策略至关重要。
{"title":"Enhancing Heart Failure Care Through Registries: Lessons Learned from Nordic Countries' Implementation of Guidelines.","authors":"Peder L Myhre,Felix Lindberg,Brian B Løgstrup,Inga J Ingimarsdottir,Maria Vistnes,Inge Schjødt,Charlotta Ljungman,Gianluigi Savarese,Nadia P Dridi,Hafsteinn Einarsson,Tomas Mellberg,Kristian Berge,Alexandre Mebazaa,Lars H Lund","doi":"10.1093/ejhf/xuag060","DOIUrl":"https://doi.org/10.1093/ejhf/xuag060","url":null,"abstract":"This review evaluates the role of heart failure (HF) registries in the Nordic countries-Sweden, Denmark, Norway, and Iceland-in the implementation of the European Society of Cardiology's guidelines for guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF). It critically examines how these registries facilitate clinical practice and enhance patient outcomes through their design, data collection methods, and the evaluation of key metrics related to GDMT implementation over time. We highlight the nurse-led models adopted by these registries, which emphasize quality benchmarks and feature real-time feedback mechanisms regarding the application of GDMT. Between 2021 and 2024, registry population-weighted estimates revealed significant increases in the utilization of key therapies: mineralocorticoid receptor antagonists rose from 51% to 72%, sodium-glucose co-transporter-2 inhibitors from 20% to 81%, and sacubitril/valsartan from 22% to 32%. The use of beta-blockers and renin-angiotensin-system inhibitors remained consistently high at 91% and 94%, respectively. These shifts were linked to better treatment outcomes. The findings underscore that HF registries play a crucial role in enhancing care quality through established drug therapies for HFrEF, offering a model for integrating data-driven methodologies into HF management. Future utilization and expansion of these registries are vital for tackling healthcare disparities and refining treatment strategies for HF patients.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"47 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147359178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Douglas E Cannie,Athanasios Bakalakos,Petros Syrris,Alexandros Protonotarios,Massimiliano Lorenzini,Oliver Guttmann,Constantinos O'Mahony,Konstantinos Savvatis,Neha Sekhri,Saidi Mohiddin,Luis R Lopes,Perry M Elliott
AIMSGenetic testing in patients with dilated cardiomyopathy (DCM) is increasingly used to guide clinical management, but international guidance does not endorse genetic testing for older patients. This study sought to explore the yield and impact of genetic testing in older patients with DCM.METHODS AND RESULTSConsecutive and unrelated genotyped patients with DCM were retrospectively recruited in a single referral centre. The yield of genetic testing was examined by age group. Genotype positive patients above and below 55 years of age were compared for a primary composite endpoint of end-stage heart failure (ESHF) or malignant ventricular arrhythmia (MVA).Six hundred and eighty-six patients (62.1% male, median [IQR] age 50 [37, 59] years) were recruited; 166 (24.2%) were genotype-positive. Sixty of 308 (19.5%) patients over 55 years of age were genotype-positive with 18 (30%) harbouring variants in genes associated with a higher risk of MVA.During a median follow-up of 50 months, twenty-one of 148 (14.2%) genotype-positive patients without baseline MVA had the primary composite endpoint with no significant difference between age groups (11/94 (11.7%) of those aged <55 years and 10/54 (18.5%) ≥55 years, log rank p value = 0.4).CONCLUSIONSOne fifth of older patients with DCM carry disease causing genetic variants, including those associated with a higher risk of MVA. Adverse event rates in older genotype-positive patients with DCM are comparable to their younger counterparts. These data highlight the value of extending genetic testing to older patients with DCM.
{"title":"The Yield and Clinical Impact of Genetic Testing in Older Patients with Dilated Cardiomyopathy.","authors":"Douglas E Cannie,Athanasios Bakalakos,Petros Syrris,Alexandros Protonotarios,Massimiliano Lorenzini,Oliver Guttmann,Constantinos O'Mahony,Konstantinos Savvatis,Neha Sekhri,Saidi Mohiddin,Luis R Lopes,Perry M Elliott","doi":"10.1093/ejhf/xuag055","DOIUrl":"https://doi.org/10.1093/ejhf/xuag055","url":null,"abstract":"AIMSGenetic testing in patients with dilated cardiomyopathy (DCM) is increasingly used to guide clinical management, but international guidance does not endorse genetic testing for older patients. This study sought to explore the yield and impact of genetic testing in older patients with DCM.METHODS AND RESULTSConsecutive and unrelated genotyped patients with DCM were retrospectively recruited in a single referral centre. The yield of genetic testing was examined by age group. Genotype positive patients above and below 55 years of age were compared for a primary composite endpoint of end-stage heart failure (ESHF) or malignant ventricular arrhythmia (MVA).Six hundred and eighty-six patients (62.1% male, median [IQR] age 50 [37, 59] years) were recruited; 166 (24.2%) were genotype-positive. Sixty of 308 (19.5%) patients over 55 years of age were genotype-positive with 18 (30%) harbouring variants in genes associated with a higher risk of MVA.During a median follow-up of 50 months, twenty-one of 148 (14.2%) genotype-positive patients without baseline MVA had the primary composite endpoint with no significant difference between age groups (11/94 (11.7%) of those aged <55 years and 10/54 (18.5%) ≥55 years, log rank p value = 0.4).CONCLUSIONSOne fifth of older patients with DCM carry disease causing genetic variants, including those associated with a higher risk of MVA. Adverse event rates in older genotype-positive patients with DCM are comparable to their younger counterparts. These data highlight the value of extending genetic testing to older patients with DCM.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
João Pedro Ferreira, Faiez Zannad, Javed Butler, Gerasimos Filippatos, Francisco Vasques-Nóvoa, Pedro Marques, João Sérgio Neves, Stefan D Anker, Milton Packer
Background: Sodium glucose co-transporter-2 inhibitors (SGLT2i) improve outcomes of patients with heart failure (HF). Urinary tract infections (UTI) are relatively common in HF, and their occurrence has been associated with an increased mortality risk. The use of SGLT2i has been associated with the occurrence of UTIs and mycotic genitourinary infections (MGI) which are a major cause of treatment discontinuation.
Aims: To study genitourinary infections in men and women with HF, their association with outcomes, and the impact of empagliflozin.
Methods: Analysis of EMPEROR-Pooled including a total of 9718 patients across the spectrum of ejection fraction. Descriptive statistics, Cox and time-varying survival models were used. The median follow-up time was 21 months.
Results: Throughout follow-up, 757 (7.8%) patients experienced a lower UTI, 60 (0.6%) MGI, and 41 pyelonephritis/urosepsis (0.4%). Genitourinary infections were more frequent in women than in men. Compared to patients without UTI/MGI, those with pyelonephritis/urosepsis were older and had higher comorbidity burden, whereas those with MGI were younger and had a higher prevalence of diabetes and obesity. Compared to placebo, empagliflozin was associated with a higher risk of lower UTI and MGI, particularly balanitis in men, but not pyelonephritis/urosepsis. The risk of death increased after UTI, but not after MGI. The effect of empagliflozin versus placebo on the composite of HF hospitalization or cardiovascular death was not modified by the occurrence of genitourinary infections.
Conclusions: Lower UTIs were relatively frequent in HF patients, whereas MGI and pyelonephritis/urosepsis were infrequent. SGLT2i increased the risk of lower UTI and MGI. Although UTI, but not MGI, were associated with a higher subsequent risk of death, the clinical benefits of SGLT2i were preserved regardless of genitourinary infection occurrence.
{"title":"Genitourinary tract infections and SGLT2 inhibitors in heart failure: an EMPEROR-Pooled analysis.","authors":"João Pedro Ferreira, Faiez Zannad, Javed Butler, Gerasimos Filippatos, Francisco Vasques-Nóvoa, Pedro Marques, João Sérgio Neves, Stefan D Anker, Milton Packer","doi":"10.1093/ejhf/xuag054","DOIUrl":"https://doi.org/10.1093/ejhf/xuag054","url":null,"abstract":"<p><strong>Background: </strong>Sodium glucose co-transporter-2 inhibitors (SGLT2i) improve outcomes of patients with heart failure (HF). Urinary tract infections (UTI) are relatively common in HF, and their occurrence has been associated with an increased mortality risk. The use of SGLT2i has been associated with the occurrence of UTIs and mycotic genitourinary infections (MGI) which are a major cause of treatment discontinuation.</p><p><strong>Aims: </strong>To study genitourinary infections in men and women with HF, their association with outcomes, and the impact of empagliflozin.</p><p><strong>Methods: </strong>Analysis of EMPEROR-Pooled including a total of 9718 patients across the spectrum of ejection fraction. Descriptive statistics, Cox and time-varying survival models were used. The median follow-up time was 21 months.</p><p><strong>Results: </strong>Throughout follow-up, 757 (7.8%) patients experienced a lower UTI, 60 (0.6%) MGI, and 41 pyelonephritis/urosepsis (0.4%). Genitourinary infections were more frequent in women than in men. Compared to patients without UTI/MGI, those with pyelonephritis/urosepsis were older and had higher comorbidity burden, whereas those with MGI were younger and had a higher prevalence of diabetes and obesity. Compared to placebo, empagliflozin was associated with a higher risk of lower UTI and MGI, particularly balanitis in men, but not pyelonephritis/urosepsis. The risk of death increased after UTI, but not after MGI. The effect of empagliflozin versus placebo on the composite of HF hospitalization or cardiovascular death was not modified by the occurrence of genitourinary infections.</p><p><strong>Conclusions: </strong>Lower UTIs were relatively frequent in HF patients, whereas MGI and pyelonephritis/urosepsis were infrequent. SGLT2i increased the risk of lower UTI and MGI. Although UTI, but not MGI, were associated with a higher subsequent risk of death, the clinical benefits of SGLT2i were preserved regardless of genitourinary infection occurrence.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147320999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Where Do Additional Medical Therapies Fit?","authors":"Stephen J Greene, Javed Butler, Gregg C Fonarow","doi":"10.1093/ejhf/xuag053","DOIUrl":"https://doi.org/10.1093/ejhf/xuag053","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter regarding the article \"Clinical profiles and prognostic impact of residual intravascular and tissue congestion in acute heart failure\".","authors":"Xinyan Qi, Jianbao Wang, Lin Chen","doi":"10.1093/ejhf/xuag050","DOIUrl":"https://doi.org/10.1093/ejhf/xuag050","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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