June 2023 at a glance: focus on worsening heart failure, heart failure with preserved ejection fraction and valvular heart disease

Episodes of worsening heart failure (HF) are landmark events in the clinical course, followed by an increased risk of hospitalizations and death.1–5 The Heart Failure Association (HFA) of the European Society of Cardiology (ESC) provided a new definition of worsening chronic HF: worsening symptoms and signs of HF in patients with pre-existing HF, requiring intensification of treatment, most often diuretic therapy. Of note, intensification of treatment also includes escalation of oral diuretics and/or admission to ambulatory or emergency department.6 A secondary analysis of the REPORT-HF (prospective international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure) registry sought to examine the utilization of healthcare resources for hospitalized patients with HF across the spectrum of left ventricular ejection fraction (LVEF). HF with reduced ejection fraction (HFrEF) was the most prevalent. The length of hospitalization was similar irrespective of LVEF. Prescription of neurohormonal antagonists was suboptimal in HFrEF at discharge, similar to what shown in other registries.7 The risk of 12-month all-cause and cardiovascular mortality were lower for HF with mildly reduced ejection fraction and HF with preserved ejection fraction (HFpEF), compared to HFrEF.8,9 Changes in plasma concentrations of biomarkers may predict the development of HF or worsening HF events.10–12 Oyama et al.13 investigated the role of three biomarkers – high-sensitivity troponin T (hsTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and growth differentiation factor-15 (GDF-15) – measured at baseline and at 12 months in predicting HF outcome among patients with atrial fibrillation enrolled in the ENGAGE AF-TIMI 48 trial. Serial measurement of hsTnT, NT-proBNP, and GDF-15 revealed that higher baseline values, and increasing or persistently elevated values over 1 year are associated with higher risk of HF outcomes in patients with atrial fibrillation regardless of HF history or HF phenotype based on LVEF. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . Heart failure with preserved ejection fraction