{"title":"Reply to the letter regarding the article ‘Urinary sodium analysis: The key to effective diuretic titration? European Journal of Heart Failure expert consensus document’","authors":"Evelyne Meekers","doi":"10.1002/ejhf.70032","DOIUrl":"https://doi.org/10.1002/ejhf.70032","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"105 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228737","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,Muthiah Vaduganathan,Brian L Claggett,Ian Kulac,John W Ostrominski,Akshay S Desai,Pardeep S Jhund,Carolyn S P Lam,Michele Senni,Sanjiv J Shah,Adriaan A Voors,Bertram Pitt,Katja Rohwedder,Meike Brinker,Patrick Schloemer,John J V McMurray,Scott D Solomon,Faiez Zannad
AIMSFinerenone improved heart failure (HF) outcomes in patients with heart failure and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). Clinical decision-making around initiation of mineralocorticoid receptor antagonists often relies on measures of kidney function and serum potassium (K+) levels. The aim of this study was to evaluate the efficacy and safety of finerenone across categories of serum K+ and estimated glomerular filtration rate (eGFR).METHODS AND RESULTSFour mutually exclusive categories were created: (1) K+ ≤4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2; (2) K+ >4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2; (3) K+ ≤4.5 mmol/L and eGFR <60 ml/min/1.73 m2; and (4) K+ >4.5 mmol/L and eGFR <60 ml/min/1.73 m2. Outcomes and treatment effects were compared across these categories. The primary outcome was a composite of total HF events and cardiovascular death. The median follow-up was 32 months. A total of 6001 patients were included. Compared to patients with K+ ≤4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2, those with eGFR <60 ml/min/1.73 m2, irrespective of K+ levels, had a 1.5- to 2-fold higher risk of experiencing primary outcome and fatal events across treatment groups. No significant interaction was observed on the effects of finerenone (vs. placebo) on the primary outcome across K+/eGFR categories. The respective risk ratios (RR) and 95% confidence intervals (CI) were: (1) K+ ≤4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2: RR 0.66, 95% CI 0.52-0.85; (2) K+ >4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2: RR 0.92, 95% CI 0.65-1.30; (3) K+ ≤4.5 mmol/L and eGFR <60 ml/min/1.73 m2: RR 0.91, 95% CI 0.74-1.13; (4) K+ >4.5 mmol/L and eGFR <60 ml/min/1.73 m2: RR 0.92, 95% CI 0.72-1.17; p for interaction = 0.20. Patients with low eGFR and/or high K+ experienced more frequent adverse events and treatment discontinuation; still, categories of K+/eGFR did not significantly modify the relative risk of adverse events with finerenone versus placebo (p for interaction > 0.1 for all adverse events).CONCLUSIONSNo significant heterogeneity was found on the effect of finerenone to reduce primary outcome events. Still, adverse events and treatment discontinuation were more frequent among patients with low eGFR and/or high K+, suggesting. that such patients may require tailored strategies to mitigate adverse events and avoid treatment discontinuation.
{"title":"Interplay of serum potassium and kidney function with finerenone in heart failure with mildly reduced or preserved ejection fraction: Findings from FINEARTS-HF.","authors":"João Pedro Ferreira,Muthiah Vaduganathan,Brian L Claggett,Ian Kulac,John W Ostrominski,Akshay S Desai,Pardeep S Jhund,Carolyn S P Lam,Michele Senni,Sanjiv J Shah,Adriaan A Voors,Bertram Pitt,Katja Rohwedder,Meike Brinker,Patrick Schloemer,John J V McMurray,Scott D Solomon,Faiez Zannad","doi":"10.1002/ejhf.70052","DOIUrl":"https://doi.org/10.1002/ejhf.70052","url":null,"abstract":"AIMSFinerenone improved heart failure (HF) outcomes in patients with heart failure and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). Clinical decision-making around initiation of mineralocorticoid receptor antagonists often relies on measures of kidney function and serum potassium (K+) levels. The aim of this study was to evaluate the efficacy and safety of finerenone across categories of serum K+ and estimated glomerular filtration rate (eGFR).METHODS AND RESULTSFour mutually exclusive categories were created: (1) K+ ≤4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2; (2) K+ >4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2; (3) K+ ≤4.5 mmol/L and eGFR <60 ml/min/1.73 m2; and (4) K+ >4.5 mmol/L and eGFR <60 ml/min/1.73 m2. Outcomes and treatment effects were compared across these categories. The primary outcome was a composite of total HF events and cardiovascular death. The median follow-up was 32 months. A total of 6001 patients were included. Compared to patients with K+ ≤4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2, those with eGFR <60 ml/min/1.73 m2, irrespective of K+ levels, had a 1.5- to 2-fold higher risk of experiencing primary outcome and fatal events across treatment groups. No significant interaction was observed on the effects of finerenone (vs. placebo) on the primary outcome across K+/eGFR categories. The respective risk ratios (RR) and 95% confidence intervals (CI) were: (1) K+ ≤4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2: RR 0.66, 95% CI 0.52-0.85; (2) K+ >4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2: RR 0.92, 95% CI 0.65-1.30; (3) K+ ≤4.5 mmol/L and eGFR <60 ml/min/1.73 m2: RR 0.91, 95% CI 0.74-1.13; (4) K+ >4.5 mmol/L and eGFR <60 ml/min/1.73 m2: RR 0.92, 95% CI 0.72-1.17; p for interaction = 0.20. Patients with low eGFR and/or high K+ experienced more frequent adverse events and treatment discontinuation; still, categories of K+/eGFR did not significantly modify the relative risk of adverse events with finerenone versus placebo (p for interaction > 0.1 for all adverse events).CONCLUSIONSNo significant heterogeneity was found on the effect of finerenone to reduce primary outcome events. Still, adverse events and treatment discontinuation were more frequent among patients with low eGFR and/or high K+, suggesting. that such patients may require tailored strategies to mitigate adverse events and avoid treatment discontinuation.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"29 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145209291","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}
Wan Ting Tay,Tiew-Hwa Katherine Teng,Wouter Ouwerkerk,John G F Cleland,Sean P Collins,Christiane E Angermann,Kenneth Dickstein,Ulf Dahlstrom,Anja Schweizer,Achim Obergfell,Kai-Hang Yiu,Mathieu Ghadanfar,Mahmoud Hassanein,Qing-Wen Ren,Wen-Li Gu,Georg Ertl,Sergio V Perrone,Gerasimos Filippatos,Carolyn S P Lam,Jasper Tromp
AIMSPolypharmacy, defined as the concurrent use of ≥5 medications, is prevalent among older adults with heart failure (HF). While guideline-directed HF medications provide therapeutic benefits, non-HF polypharmacy, particularly involving inappropriate medications, may lead to adverse outcomes. The international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT-HF), the largest available global acute HF registry, was used to examine the prevalence, clinical correlates, and 1-year outcome associations of non-HF polypharmacy.METHODS AND RESULTSMedication counts were classified as no polypharmacy (<5), polypharmacy (5-9), and hyper-polypharmacy (≥10). Potentially harmful medications were identified using the 2016 American Heart Association scientific statement. Multivariable regression models examined correlates of polypharmacy and 1-year mortality. Among 18 030 patients (66 ± 14 years, 39% women), 39% had polypharmacy and 9% had hyper-polypharmacy (63% and 25%, respectively, if including HF medications). Non-HF polypharmacy was more common in older white patients from high-income countries, with preserved ejection fraction and high comorbidity burden. Patients with greater non-HF medication use were less likely to receive guideline-directed HF medications and more likely to take medications that can worsen HF. Crude hazard ratios (HRs) for 1-year mortality were 1.16 (95% confidence interval [CI] 1.08-1.25) for polypharmacy and 1.46 (95% CI 1.31-1.63) for hyper-polypharmacy versus no polypharmacy. After adjustment, hyper-polypharmacy remained associated with increased mortality (HR 1.16, 95% CI 1.01-1.33).CONCLUSIONSNon-HF polypharmacy in HF is common worldwide, particularly in high-income regions. Its association with reduced use of guideline-directed HF medications and higher usage of medications causing or worsening HF, as well as elevated 1-year mortality, underscores the importance of addressing polypharmacy in HF.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov NCT02595814.
AIMSPolypharmacy，定义为同时使用≥5种药物，在老年心力衰竭（HF）患者中普遍存在。虽然指南指导的心衰药物提供治疗益处，但非心衰多药治疗，特别是涉及不适当的药物治疗，可能导致不良后果。通过纵向观察评估心力衰竭治疗医疗实践的国际注册（REPORT-HF）是全球最大的急性心力衰竭注册，用于检查非心力衰竭多药的患病率、临床相关性和1年结局相关性。方法与结果用药计数分为无多药（<5）、多药（5-9）和超多药（≥10）。根据2016年美国心脏协会的科学声明，发现了可能有害的药物。多变量回归模型检验了多药与1年死亡率的相关性。18030例患者（66±14岁，39%为女性）中，39%为多药，9%为超多药（如果包括心衰药物，分别为63%和25%）。非心衰多重用药在高收入国家的老年白人患者中更为常见，他们的射血分数保持不变，合并症负担高。非心衰药物使用较多的患者较少接受指南指导的心衰药物治疗，更有可能服用可加重心衰的药物。综合用药组1年死亡率的粗风险比（hr）为1.16(95%可信区间[CI] 1.08-1.25)，超综合用药组与非综合用药组的粗风险比为1.46 （95% CI 1.31-1.63）。调整后，过度多药仍与死亡率增加相关（HR 1.16, 95% CI 1.01-1.33）。结论非HF多药治疗在世界范围内普遍存在，特别是在高收入地区。它与指南指导的心衰药物使用减少、导致或加重心衰的药物使用增加以及1年死亡率升高有关，强调了解决心衰多药治疗的重要性。临床试验注册：clinicaltrials .gov NCT02595814。
{"title":"Global patterns of polypharmacy after acute heart failure hospitalization: Prevalence and outcomes from the REPORT-HF registry.","authors":"Wan Ting Tay,Tiew-Hwa Katherine Teng,Wouter Ouwerkerk,John G F Cleland,Sean P Collins,Christiane E Angermann,Kenneth Dickstein,Ulf Dahlstrom,Anja Schweizer,Achim Obergfell,Kai-Hang Yiu,Mathieu Ghadanfar,Mahmoud Hassanein,Qing-Wen Ren,Wen-Li Gu,Georg Ertl,Sergio V Perrone,Gerasimos Filippatos,Carolyn S P Lam,Jasper Tromp","doi":"10.1002/ejhf.70056","DOIUrl":"https://doi.org/10.1002/ejhf.70056","url":null,"abstract":"AIMSPolypharmacy, defined as the concurrent use of ≥5 medications, is prevalent among older adults with heart failure (HF). While guideline-directed HF medications provide therapeutic benefits, non-HF polypharmacy, particularly involving inappropriate medications, may lead to adverse outcomes. The international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT-HF), the largest available global acute HF registry, was used to examine the prevalence, clinical correlates, and 1-year outcome associations of non-HF polypharmacy.METHODS AND RESULTSMedication counts were classified as no polypharmacy (<5), polypharmacy (5-9), and hyper-polypharmacy (≥10). Potentially harmful medications were identified using the 2016 American Heart Association scientific statement. Multivariable regression models examined correlates of polypharmacy and 1-year mortality. Among 18 030 patients (66 ± 14 years, 39% women), 39% had polypharmacy and 9% had hyper-polypharmacy (63% and 25%, respectively, if including HF medications). Non-HF polypharmacy was more common in older white patients from high-income countries, with preserved ejection fraction and high comorbidity burden. Patients with greater non-HF medication use were less likely to receive guideline-directed HF medications and more likely to take medications that can worsen HF. Crude hazard ratios (HRs) for 1-year mortality were 1.16 (95% confidence interval [CI] 1.08-1.25) for polypharmacy and 1.46 (95% CI 1.31-1.63) for hyper-polypharmacy versus no polypharmacy. After adjustment, hyper-polypharmacy remained associated with increased mortality (HR 1.16, 95% CI 1.01-1.33).CONCLUSIONSNon-HF polypharmacy in HF is common worldwide, particularly in high-income regions. Its association with reduced use of guideline-directed HF medications and higher usage of medications causing or worsening HF, as well as elevated 1-year mortality, underscores the importance of addressing polypharmacy in HF.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov NCT02595814.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"5 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194881","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}
Alberto Aimo, Pau Codina, Matthew M.Y. Lee, Daniela Tomasoni, Michael Böhm
{"title":"What's new in heart failure? August 2025","authors":"Alberto Aimo, Pau Codina, Matthew M.Y. Lee, Daniela Tomasoni, Michael Böhm","doi":"10.1002/ejhf.70020","DOIUrl":"10.1002/ejhf.70020","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 8","pages":"1375-1378"},"PeriodicalIF":10.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190532","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}
Robert J Mentz,Javed Butler,Ciaran J McMullan,Daniel M Wojdyla,Kevin J Anstrom,Irina Barash,Marc P Bonaca,Maria Borentain,Stefano Corda,Justin A Ezekowitz,Davis Gates,Carolyn S P Lam,Eldrin F Lewis,JoAnn Lindenfeld,Christopher M O'Connor,Piotr Ponikowski,Yogesh N V Reddy,Giuseppe M C Rosano,Clara Saldarriaga,Michele Senni,Pedro Pinto Teixeira,James Udelson,Alessia Urbinati,Vanja Vlajnic,Adriaan A Voors,Aiwen Xing,Faiez Zannad,
AIMSThe efficacy and safety of vericiguat in patients with chronic heart failure with reduced ejection fraction (HFrEF) on contemporary heart failure (HF) therapies and without recent worsening was investigated in the VICTOR trial, yet some subgroups may be more susceptible to symptomatic hypotension.METHODS AND RESULTSAmong VICTOR trial participants that received at least one dose of study drug or placebo, we describe the systolic blood pressure (SBP) trajectories over time (mean change from baseline), symptomatic hypotension events and efficacy of vericiguat in potentially vulnerable patient subgroups: lower baseline blood pressure (SBP ≤110 mmHg), older patients (>75 years) and those taking angiotensin receptor-neprilysin inhibitors (ARNI) or sodium-glucose co-transporter 2 inhibitors (SGLT2i) at baseline. The efficacy outcomes of cardiovascular death and HF hospitalization and cardiovascular death alone across baseline SBP were examined using Cox proportional hazards models. Overall SBP trajectories showed a small initial decline from baseline in vericiguat-treated patients compared with placebo (placebo-corrected differences of -1.17 [-1.84, -0.50], p = 0.0007) that was relatively stable throughout follow-up. This trajectory was similar in those >75 years (vs. younger) as well as those receiving ARNI or SGLT2i (as compared with those not receiving these) or those with SBP ≤110 mmHg at baseline (compared with >110 mmHg). Symptomatic hypotension occurred in 11.3% of vericiguat-treated patients compared with 9.2% of placebo-treated patients with an adjusted hazard ratio of 1.24 (95% confidence interval 1.06-1.46), which was similar across age, SBP, SGLT2i and ARNI groups (all interaction p >0.05). The treatment effect of vericiguat compared with placebo on the efficacy outcomes was similar across the spectrum of baseline SBP (both interaction p >0.15).CONCLUSIONSVericiguat showed a slight adjusted decrease in SBP and resulted in more symptomatic hypotension compared with placebo but was overall well-tolerated in a broad population with HFrEF on contemporary therapy even among those predisposed to hypotension. Treatment effects on efficacy outcomes were consistent regardless of baseline SBP.
{"title":"Blood pressure, safety and clinical efficacy of vericiguat in chronic heart failure with reduced ejection fraction: Insights from the VICTOR trial.","authors":"Robert J Mentz,Javed Butler,Ciaran J McMullan,Daniel M Wojdyla,Kevin J Anstrom,Irina Barash,Marc P Bonaca,Maria Borentain,Stefano Corda,Justin A Ezekowitz,Davis Gates,Carolyn S P Lam,Eldrin F Lewis,JoAnn Lindenfeld,Christopher M O'Connor,Piotr Ponikowski,Yogesh N V Reddy,Giuseppe M C Rosano,Clara Saldarriaga,Michele Senni,Pedro Pinto Teixeira,James Udelson,Alessia Urbinati,Vanja Vlajnic,Adriaan A Voors,Aiwen Xing,Faiez Zannad, ","doi":"10.1002/ejhf.70033","DOIUrl":"https://doi.org/10.1002/ejhf.70033","url":null,"abstract":"AIMSThe efficacy and safety of vericiguat in patients with chronic heart failure with reduced ejection fraction (HFrEF) on contemporary heart failure (HF) therapies and without recent worsening was investigated in the VICTOR trial, yet some subgroups may be more susceptible to symptomatic hypotension.METHODS AND RESULTSAmong VICTOR trial participants that received at least one dose of study drug or placebo, we describe the systolic blood pressure (SBP) trajectories over time (mean change from baseline), symptomatic hypotension events and efficacy of vericiguat in potentially vulnerable patient subgroups: lower baseline blood pressure (SBP ≤110 mmHg), older patients (>75 years) and those taking angiotensin receptor-neprilysin inhibitors (ARNI) or sodium-glucose co-transporter 2 inhibitors (SGLT2i) at baseline. The efficacy outcomes of cardiovascular death and HF hospitalization and cardiovascular death alone across baseline SBP were examined using Cox proportional hazards models. Overall SBP trajectories showed a small initial decline from baseline in vericiguat-treated patients compared with placebo (placebo-corrected differences of -1.17 [-1.84, -0.50], p = 0.0007) that was relatively stable throughout follow-up. This trajectory was similar in those >75 years (vs. younger) as well as those receiving ARNI or SGLT2i (as compared with those not receiving these) or those with SBP ≤110 mmHg at baseline (compared with >110 mmHg). Symptomatic hypotension occurred in 11.3% of vericiguat-treated patients compared with 9.2% of placebo-treated patients with an adjusted hazard ratio of 1.24 (95% confidence interval 1.06-1.46), which was similar across age, SBP, SGLT2i and ARNI groups (all interaction p >0.05). The treatment effect of vericiguat compared with placebo on the efficacy outcomes was similar across the spectrum of baseline SBP (both interaction p >0.15).CONCLUSIONSVericiguat showed a slight adjusted decrease in SBP and resulted in more symptomatic hypotension compared with placebo but was overall well-tolerated in a broad population with HFrEF on contemporary therapy even among those predisposed to hypotension. Treatment effects on efficacy outcomes were consistent regardless of baseline SBP.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"20 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182607","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}
Gad Cotter,Jan Biegus,Marat Fudim,Òscar Miró,Andrew P Ambrosy,Matteo Pagnesi,Ovidiu Chioncel,Beth Davison,Yonathan Freund,Edimar A Bocchi,Javed Butler,Anastase Dzudie,Sivadasanpillai Harikrishnan,Ivna C G V Lima,Robert J Mentz,Siti E Nauli,Mauro Riccardi,Naoki Sato,Gianluigi Savarese,Karen Sliwa,Yuhui Zhang,Jingmin Zhou,Alexandre Mebazaa,Sean Collins
The care of patients hospitalized for acute heart failure (AHF) has been largely unchanged from the early 1960s until a few years ago, consisting mainly of oxygen and diuretics supplemented sometimes by other vasoactive drugs. These treatments, although effective in the short term in controlling congestion, do not prevent early readmissions and death, occurring in over 30% of patients in the 6 months after an AHF hospitalization. In the last years, studies showed that AHF diagnosis can be improved, early diuretic care can be optimized, and early intensive therapy with combined drug regimens can reduce the rate of adverse outcomes. However, unlike acute coronary syndromes, where guidelines have existed since 1996, there are no separate detailed guidelines for AHF. In a series of four papers (International Expert Opinion Series on AHF Management) an international expert group highlights important aspects of AHF care where the evidence base to inform clinical practice is lacking. These papers focus on (1) diagnosis and treatment during prehospital and in the emergency department, (2) management during the first days of admission, (3) care before and after AHF discharge, and (4) hospitalized AHF management in patients presenting with cardiogenic shock, significant valvular disease, or end-stage renal disease. These papers are not intended to serve as guidelines, but rather to suggest a framework for future recommendations for the diagnosis and treatment of AHF. In the current summary paper, we highlight the main considerations and key recommendations in each of the parts of AHF care.
{"title":"Acute heart failure care - a consensus series of an international experts' group.","authors":"Gad Cotter,Jan Biegus,Marat Fudim,Òscar Miró,Andrew P Ambrosy,Matteo Pagnesi,Ovidiu Chioncel,Beth Davison,Yonathan Freund,Edimar A Bocchi,Javed Butler,Anastase Dzudie,Sivadasanpillai Harikrishnan,Ivna C G V Lima,Robert J Mentz,Siti E Nauli,Mauro Riccardi,Naoki Sato,Gianluigi Savarese,Karen Sliwa,Yuhui Zhang,Jingmin Zhou,Alexandre Mebazaa,Sean Collins","doi":"10.1002/ejhf.70057","DOIUrl":"https://doi.org/10.1002/ejhf.70057","url":null,"abstract":"The care of patients hospitalized for acute heart failure (AHF) has been largely unchanged from the early 1960s until a few years ago, consisting mainly of oxygen and diuretics supplemented sometimes by other vasoactive drugs. These treatments, although effective in the short term in controlling congestion, do not prevent early readmissions and death, occurring in over 30% of patients in the 6 months after an AHF hospitalization. In the last years, studies showed that AHF diagnosis can be improved, early diuretic care can be optimized, and early intensive therapy with combined drug regimens can reduce the rate of adverse outcomes. However, unlike acute coronary syndromes, where guidelines have existed since 1996, there are no separate detailed guidelines for AHF. In a series of four papers (International Expert Opinion Series on AHF Management) an international expert group highlights important aspects of AHF care where the evidence base to inform clinical practice is lacking. These papers focus on (1) diagnosis and treatment during prehospital and in the emergency department, (2) management during the first days of admission, (3) care before and after AHF discharge, and (4) hospitalized AHF management in patients presenting with cardiogenic shock, significant valvular disease, or end-stage renal disease. These papers are not intended to serve as guidelines, but rather to suggest a framework for future recommendations for the diagnosis and treatment of AHF. In the current summary paper, we highlight the main considerations and key recommendations in each of the parts of AHF care.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"96 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182677","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}
Yvonne Huber,Lea Hofmann,Jürgen H Prochaska,Thomas Koeck,Julian Chalabi,Norbert Pfeiffer,Manfred Beutel,Konstantin Strauch,Karl J Lackner,Oliver Tüscher,Thomas Münzel,Matthias M Weber,Julia Weinmann-Menke,Philipp Wild,Peter R Galle,Jörn M Schattenberg
AIMSMajor adverse cardiovascular events (MACE) related to cardiovascular disease are a major cause of death in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We explored the impact of MASLD on incident MACE and overall mortality in the general population in Germany.METHODS AND RESULTSA total of 14 575 patients were included for the analysis. Elevated liver enzymes were present in 21.7% and MASLD, defined with a positive fatty liver index (FLI) in the absence of relevant alcohol use, was detected in 37% of participants. MACE were defined as a three-item composite endpoint of acute myocardial infarction (AMI), stroke and cardiovascular mortality (3-point MACE) and extended MACE (eMACE) including MACE criteria, incident atrial fibrillation and pulmonary embolism. In the group with a positive FLI (≥60) a higher rate of male sex and a higher age as well as a higher prevalence of metabolic and cardiovascular risk factors compared to the group with a negative FLI (<30) were present. At 5 years of follow-up, 475 patients (3.7%) developed 3-point MACE and 577 (4.9%) developed eMACE. In the subgroup with MASLD, the incidence of eMACE was higher (7.1% vs. 3.7%; p < 0.0001). Using Cox regression analysis with a stepwise adjustment strategy, we were able to show an independent prediction of MACE and eMACE by hepatic steatosis under consideration of various confounders. The presence of MASLD was associated with an increased risk of developing MACE by 62.3% (p < 0.0001) and eMACE by 44.0% (p < 0.0001). Importantly, MASLD was associated with an increased risk for all-cause mortality (hazard ratio 1.55; p < 0.0001).CONCLUSIONSMetabolic dysfunction-associated steatotic liver disease is an independent risk factor for MACE and is associated with a significantly increased risk of all-cause mortality. In the management of patients with cardiovascular risk, identification of MASLD can potentially refine their disease trajectory.
目的：与心血管疾病相关的主要不良心血管事件（MACE）是代谢功能障碍相关脂肪变性肝病（MASLD）患者死亡的主要原因。我们探讨了MASLD对德国普通人群MACE事件和总死亡率的影响。方法与结果共纳入14 575例患者进行分析。21.7%的参与者存在肝酶升高，37%的参与者检测到MASLD，即在没有相关酒精使用的情况下脂肪肝指数（FLI）呈阳性。MACE被定义为急性心肌梗死（AMI）、卒中和心血管死亡率（3点MACE）和扩展MACE （eMACE）的三项复合终点，包括MACE标准、房颤事件和肺栓塞。在FLI阳性组（≥60）中，与FLI阴性组（<30）相比，男性比例更高，年龄更高，代谢和心血管危险因素的患病率也更高。随访5年，475例（3.7%）发生3点MACE， 577例（4.9%）发生eMACE。在MASLD亚组中，eMACE的发生率更高（7.1% vs. 3.7%; p < 0.0001）。使用Cox回归分析和逐步调整策略，我们能够在考虑各种混杂因素的情况下，显示肝脏脂肪变性对MACE和eMACE的独立预测。MASLD的存在与发生MACE的风险增加62.3% （p < 0.0001）和eMACE风险增加44.0% （p < 0.0001）相关。重要的是，MASLD与全因死亡风险增加相关（风险比1.55;p < 0.0001）。结论：代谢功能障碍相关的脂肪变性肝病是MACE的独立危险因素，并与全因死亡率的显著增加相关。在心血管风险患者的管理中，MASLD的识别可以潜在地改善他们的疾病轨迹。
{"title":"Incidence of major cardiovascular events in patients with metabolic dysfunction-associated steatotic liver disease in the general population.","authors":"Yvonne Huber,Lea Hofmann,Jürgen H Prochaska,Thomas Koeck,Julian Chalabi,Norbert Pfeiffer,Manfred Beutel,Konstantin Strauch,Karl J Lackner,Oliver Tüscher,Thomas Münzel,Matthias M Weber,Julia Weinmann-Menke,Philipp Wild,Peter R Galle,Jörn M Schattenberg","doi":"10.1002/ejhf.70053","DOIUrl":"https://doi.org/10.1002/ejhf.70053","url":null,"abstract":"AIMSMajor adverse cardiovascular events (MACE) related to cardiovascular disease are a major cause of death in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We explored the impact of MASLD on incident MACE and overall mortality in the general population in Germany.METHODS AND RESULTSA total of 14 575 patients were included for the analysis. Elevated liver enzymes were present in 21.7% and MASLD, defined with a positive fatty liver index (FLI) in the absence of relevant alcohol use, was detected in 37% of participants. MACE were defined as a three-item composite endpoint of acute myocardial infarction (AMI), stroke and cardiovascular mortality (3-point MACE) and extended MACE (eMACE) including MACE criteria, incident atrial fibrillation and pulmonary embolism. In the group with a positive FLI (≥60) a higher rate of male sex and a higher age as well as a higher prevalence of metabolic and cardiovascular risk factors compared to the group with a negative FLI (<30) were present. At 5 years of follow-up, 475 patients (3.7%) developed 3-point MACE and 577 (4.9%) developed eMACE. In the subgroup with MASLD, the incidence of eMACE was higher (7.1% vs. 3.7%; p < 0.0001). Using Cox regression analysis with a stepwise adjustment strategy, we were able to show an independent prediction of MACE and eMACE by hepatic steatosis under consideration of various confounders. The presence of MASLD was associated with an increased risk of developing MACE by 62.3% (p < 0.0001) and eMACE by 44.0% (p < 0.0001). Importantly, MASLD was associated with an increased risk for all-cause mortality (hazard ratio 1.55; p < 0.0001).CONCLUSIONSMetabolic dysfunction-associated steatotic liver disease is an independent risk factor for MACE and is associated with a significantly increased risk of all-cause mortality. In the management of patients with cardiovascular risk, identification of MASLD can potentially refine their disease trajectory.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"1 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140317","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}
Marta Gigli,Job A J Verdonschot,Pablo Garcia-Pavia,Davide Stolfo,Lorenzo Monserrat,Sanjay Prasad,Andrea Mazzanti,Folkert W Asselbergs,Barbara Bauce,Philippe Charron,Dana Dawson,Brian P Halliday,Luisa Mestroni,Petar Seferovic,Upasana Tayal,Maria Teresa Tome Esteban,Peter Van Tintelen,Stephane Heymans,Antonis Pantazis,Marco Metra,Gianfranco Sinagra
The risk of sudden cardiac death (SCD) in the general population of patients with dilated cardiomyopathy (DCM) has progressively declined with the implementation of novel medical strategies. However, still cases occur in young individuals and the challenge of risk stratification remains unsolved. Traditional criteria, including left ventricular ejection fraction, have demonstrated their profound weakness to identify subjects at high risk of SCD in this specific context. The increasing availability of genetic information has allowed identification of certain genotypes with a high arrhythmic risk that deserve a more individualized approach. Recent European guidelines recognized the contribution of genetic information in clinical decision-making. Gene-specific risk stratification tools have been developed, and in some cases externally validated, which can support clinicians in the decisions on SCD primary prevention interventions. However, they are generally based on basic variables, whereas the growing amount of knowledge on novel methods for risk prediction, and in particular the solid data on the predictive value of cardiac magnetic resonance tissue characterization (i.e. late gadolinium enhancement) are not incorporated in available scores, and more in general, are not systematically part of the clinical work-up. In this scientific statement, we summarized the current state of the art concerning the risk stratification of SCD in DCM, with particular emphasis on genetic forms, highlight the weaknesses of the available strategies and the potential actions needed for improving them. Available risk stratification tools are discussed, and methodologies that should be incorporated in future prognostication models are summarized. Lastly, a point-by-point summary of the key prerequisites for developing the future arrhythmogenic risk scores in patients with DCM is provided.
{"title":"Future development of arrhythmogenic risk scores in patients with heart failure and inherited dilated cardiomyopathy. A scientific statement of the Heart Failure Association of the ESC.","authors":"Marta Gigli,Job A J Verdonschot,Pablo Garcia-Pavia,Davide Stolfo,Lorenzo Monserrat,Sanjay Prasad,Andrea Mazzanti,Folkert W Asselbergs,Barbara Bauce,Philippe Charron,Dana Dawson,Brian P Halliday,Luisa Mestroni,Petar Seferovic,Upasana Tayal,Maria Teresa Tome Esteban,Peter Van Tintelen,Stephane Heymans,Antonis Pantazis,Marco Metra,Gianfranco Sinagra","doi":"10.1002/ejhf.70042","DOIUrl":"https://doi.org/10.1002/ejhf.70042","url":null,"abstract":"The risk of sudden cardiac death (SCD) in the general population of patients with dilated cardiomyopathy (DCM) has progressively declined with the implementation of novel medical strategies. However, still cases occur in young individuals and the challenge of risk stratification remains unsolved. Traditional criteria, including left ventricular ejection fraction, have demonstrated their profound weakness to identify subjects at high risk of SCD in this specific context. The increasing availability of genetic information has allowed identification of certain genotypes with a high arrhythmic risk that deserve a more individualized approach. Recent European guidelines recognized the contribution of genetic information in clinical decision-making. Gene-specific risk stratification tools have been developed, and in some cases externally validated, which can support clinicians in the decisions on SCD primary prevention interventions. However, they are generally based on basic variables, whereas the growing amount of knowledge on novel methods for risk prediction, and in particular the solid data on the predictive value of cardiac magnetic resonance tissue characterization (i.e. late gadolinium enhancement) are not incorporated in available scores, and more in general, are not systematically part of the clinical work-up. In this scientific statement, we summarized the current state of the art concerning the risk stratification of SCD in DCM, with particular emphasis on genetic forms, highlight the weaknesses of the available strategies and the potential actions needed for improving them. Available risk stratification tools are discussed, and methodologies that should be incorporated in future prognostication models are summarized. Lastly, a point-by-point summary of the key prerequisites for developing the future arrhythmogenic risk scores in patients with DCM is provided.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"13 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133958","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}
AIMSThe Central/Eastern Europe (CEE) Quality of Care Centres (QCC) Survey evaluated the implementation of guideline-directed medical therapies (GDMT) and device use at discharge after heart failure (HF) hospitalization in CEE, where GDMT underutilization remains a concern.METHODS AND RESULTSBetween March 2024 and January 2025, 2251 patients (mean age 70.0 years, 60.4% male) were enrolled at discharge from 21 centres across 12 CEE countries. The patient population included HF with reduced ejection fraction (HFrEF) (55.5%), HF with mildly reduced ejection fraction (15.3%) and HF with preserved ejection fraction (27.9%). In the total population, from admission to discharge there was a increase in the use of angiotensin receptor-neprilysin inhibitor (ARNI) (17.1% to 34.3%), beta-blockers (69.4% to 92.4%), mineralocorticoid receptor antagonists (MRA) (44.0% to 82.1%) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) (30.8% to 79.9%), with a reduction in angiotensin-converting enzyme inhibitor (ACEI) use (all p < 0.05). Similar trends were observed across HF phenotypes, including HFrEF (increased use of ARNI, 26.3% to 55.1%, beta-blockers, 69.8% to 95.3%, MRA 49.5% to 89.0%, and SGLT2I 36.2% to 79.8%, and lower ACEI use, all p < 0.05). At discharge, 53.5% of patients received quadruple therapy (63.9% with HFrEF), while ≥50% target doses of titratable drugs were achieved in 18.8% (17.8% in HFrEF). Predictors of GDMT underuse included older age, lower education, living alone, non-ischaemic HF, higher ejection fraction, chronic kidney disease, hypotension, hyperkalaemia, prolonged hospitalization, and residual oedema. Among eligible HFrEF patients, 21.3% were discharged with, or referred for implantable cardioverter-defibrillator, and 17.4% for cardiac resynchronization therapy.CONCLUSIONSThe CEE-QCC Survey highlights substantial in-hospital GDMT implementation and up-titration, though device use remains limited. Targeted strategies are needed to enhance guideline implementation and ensure optimal HF care across the CEE region.
{"title":"Contemporary implementation of guideline-directed medical and device therapies in heart failure: Insights from the Central/Eastern Europe Quality of Care Centres Survey.","authors":"Petar M Seferović,Marija Polovina,Jan Krejči,Bela Merkely,Mariya Tokmakova,Martin Huelssmann,Vladimir Miloradović,Svetlana Apostolović,Elizabeta Srbinovska-Kostovska,Slavica Radovanović,Anastazija Stojšić-Milosavljević,Aleksandra Milovančev,Marija Zdravković,Duška Glavaš,Tamara Preradović-Kovačević,Eva Goncalvesova,Michal Laufer-Perl,Nataša Marković-Nikolić,Zumreta Kušljugić,Larisa Hudić-Dizdarević,Dan Gaita,Ginta Kamzola,Robert Sepp,Dragan Simić,Arsen Ristić,Milika Ašanin,Gordana Krljanac,Petar Otašević,Dejana Stanisavljević,Davor Miličić,Magdy Abdelhamid,Gianluigi Savarese, ","doi":"10.1002/ejhf.70031","DOIUrl":"https://doi.org/10.1002/ejhf.70031","url":null,"abstract":"AIMSThe Central/Eastern Europe (CEE) Quality of Care Centres (QCC) Survey evaluated the implementation of guideline-directed medical therapies (GDMT) and device use at discharge after heart failure (HF) hospitalization in CEE, where GDMT underutilization remains a concern.METHODS AND RESULTSBetween March 2024 and January 2025, 2251 patients (mean age 70.0 years, 60.4% male) were enrolled at discharge from 21 centres across 12 CEE countries. The patient population included HF with reduced ejection fraction (HFrEF) (55.5%), HF with mildly reduced ejection fraction (15.3%) and HF with preserved ejection fraction (27.9%). In the total population, from admission to discharge there was a increase in the use of angiotensin receptor-neprilysin inhibitor (ARNI) (17.1% to 34.3%), beta-blockers (69.4% to 92.4%), mineralocorticoid receptor antagonists (MRA) (44.0% to 82.1%) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) (30.8% to 79.9%), with a reduction in angiotensin-converting enzyme inhibitor (ACEI) use (all p < 0.05). Similar trends were observed across HF phenotypes, including HFrEF (increased use of ARNI, 26.3% to 55.1%, beta-blockers, 69.8% to 95.3%, MRA 49.5% to 89.0%, and SGLT2I 36.2% to 79.8%, and lower ACEI use, all p < 0.05). At discharge, 53.5% of patients received quadruple therapy (63.9% with HFrEF), while ≥50% target doses of titratable drugs were achieved in 18.8% (17.8% in HFrEF). Predictors of GDMT underuse included older age, lower education, living alone, non-ischaemic HF, higher ejection fraction, chronic kidney disease, hypotension, hyperkalaemia, prolonged hospitalization, and residual oedema. Among eligible HFrEF patients, 21.3% were discharged with, or referred for implantable cardioverter-defibrillator, and 17.4% for cardiac resynchronization therapy.CONCLUSIONSThe CEE-QCC Survey highlights substantial in-hospital GDMT implementation and up-titration, though device use remains limited. Targeted strategies are needed to enhance guideline implementation and ensure optimal HF care across the CEE region.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"93 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133960","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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