Christiane E Angermann, Folkert W Asselbergs, Georg Ertl, Stefan Störk
{"title":"Personalized Remote Patient Management in Heart Failure : From Implanted Hemodynamic Monitoring Toward an Artificial Intelligence-Supported Adaptive Care Cycle.","authors":"Christiane E Angermann, Folkert W Asselbergs, Georg Ertl, Stefan Störk","doi":"10.1007/s11897-026-00783-8","DOIUrl":"https://doi.org/10.1007/s11897-026-00783-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Implanted pulmonary artery pressure (PAP) monitoring provides an early window on imminent worsening heart failure (HF). Randomized trials demonstrated that PAP-guided management significantly reduces HF hospitalizations, but substantial residual risk persists despite recent major advances in HF pharmacotherapy. We review lessons from PAP-guided remote patient management and examine how artificial intelligence (AI) could support more individualized eligibility assessment and multimodal longitudinal surveillance within a patient-centered adaptive care cycle to further improve clinical outcomes.</p><p><strong>Recent findings: </strong>HF is increasingly recognized as a systemic disease characterized, across HF phenotypes, by multiple cardiac and non-cardiac comorbidities. CHAMPION, GUIDE-HF, and MONITOR-HF did not systematically incorporate comorbidity-related risk into patient selection, while PAP-guided treatment focused predominantly on diuretic adjustment, and monitoring strategies were not adapted to individual disease trajectories. AI could help integrate multidimensional phenotyping to estimate individual risk and expected benefit pre-implant, use comprehensive longitudinal monitoring data to support personalized, actionable clinical decision-making, and enable dynamic adaptation of monitoring intensity tailored to the disease trajectory. This may improve clinical outcomes, reduce healthcare professional workload, enhance patient experience and treatment adherence, and increase cost-effectiveness.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Precision Immunosuppression in Heart Transplantation: Biomarker-Guided Therapy Comes of Age.","authors":"Karthik Sreedhara, Palak Shah","doi":"10.1007/s11897-026-00784-7","DOIUrl":"10.1007/s11897-026-00784-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>Heart transplantation is the definitive treatment for end-stage heart failure. While the number of heart transplant performed yearly in the United States has nearly doubled in the last decade, median survival has stagnated, largely due to the complications posed by lifelong immunosuppression. A shift towards precision medicine is needed to achieve the optimal balance between risk of allograft rejection and drug-related toxicities to improve post-transplant outcomes.</p><p><strong>Recent findings: </strong>Novel molecular based diagnostic tools and biomarkers are being investigated, and hold promise in evaluating graft health and assessing immune state. The use of circulating biomarkers and molecular diagnostics such as human and viral cell-free DNA, tissue-based gene expression profiling, and circulating microRNAs, will allow for more comprehensive assessment of post-transplant immune activity and rejection risk to personalize patient care.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eline Verghote, Vanessa P M van Empel, Job A J Verdonschot
{"title":"Clonal Hematopoiesis and Inflammatory Pathways in Heart Failure with Preserved Ejection Fraction.","authors":"Eline Verghote, Vanessa P M van Empel, Job A J Verdonschot","doi":"10.1007/s11897-026-00779-4","DOIUrl":"10.1007/s11897-026-00779-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to examine the role of clonal hematopoiesis of indeterminate potential (CHIP) in the pathophysiology of heart failure with preserved ejection fraction (HFpEF), focusing on its contribution to inflammation, disease development, and clinical implications.</p><p><strong>Recent findings: </strong>Recent studies demonstrate that CHIP is enriched in HFpEF populations and is associated with increased disease risk and worse clinical outcomes. Mechanistically, CHIP promotes inflammatory signaling through activation of pathways such as the NLRP3 inflammasome and IL-1β/IL-6 axis. TET2 mutations, in particular, have been consistently linked to diastolic dysfunction and adverse remodeling, especially in patients with high inflammatory burden and cardiometabolic comorbidities. CHIP represents a novel link between ageing, inflammation, and HFpEF, contributing to disease heterogeneity and progression. It may serve as a biomarker for early detection, risk stratification, and patient phenotyping, while also offering potential therapeutic targets. Future research should focus on validating these findings and integrating CHIP into precision medicine approaches for HFpEF.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Niels A Stens, Yoram Müller-Jabusch, Kiki E L A Veenhof, Wilhelmina F Goevaerts, Mark Larooi, Jill Bay, Daan M Janssen, Annelieke Driessen, Isabella Kardys, Hendrik Koffijberg, Frank R Halfwerk, Robert M A van der Boon, Karin Dijkstra, Rudolf B Kool, Thijs M H Eijsvogels, Annemien E van den Bosch, Hareld M C Kemps, Dick H J Thijssen
{"title":"The Future of Cardiac Care: A Review on the Role for Non-Invasive, Home-Based Monitoring and Rehabilitation after Hospitalisation for Acute Decompensated Heart Failure.","authors":"Niels A Stens, Yoram Müller-Jabusch, Kiki E L A Veenhof, Wilhelmina F Goevaerts, Mark Larooi, Jill Bay, Daan M Janssen, Annelieke Driessen, Isabella Kardys, Hendrik Koffijberg, Frank R Halfwerk, Robert M A van der Boon, Karin Dijkstra, Rudolf B Kool, Thijs M H Eijsvogels, Annemien E van den Bosch, Hareld M C Kemps, Dick H J Thijssen","doi":"10.1007/s11897-026-00778-5","DOIUrl":"10.1007/s11897-026-00778-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>Heart failure (HF) is characterised by recurrent decompensation leading to worsening of symptoms and unplanned hospitalisations. Patients often experience poor post-hospitalisation recovery, fail to maintain functional capacity, and demonstrate a high risk for re-admission. In this review we discuss these challenges, and explore how non-invasive, digital solutions may improve health outcomes.</p><p><strong>Recent findings: </strong>In contrast to current episodic surveillance, advances in wearable sensor technologies enable continuous, non-invasive monitoring to facilitate physiology-guided management to improve early clinical stabilisation. Additionally, trials have highlighted the potential of exercise-based cardiac rehabilitation to improve functional capacity in HF patients. Finally, continuous monitoring of relevant physiological signals, through developing algorithms, have the potential for early prediction of clinical deterioration. Non-invasive, co-created digital solutions may facilitate early stabilisation, improve functional capacity and predict clinical deterioration following episodes of decompensation. Collectively, they may enhance clinical outcomes and quality of life in patients with HF.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Exercise, Nutrition and GLP-1 Medicines to Improve Body Weight and Muscle Function in Heart Failure with Preserved Ejection Fraction.","authors":"Konstantinos Prokopidis, Aniket Sunil Joshi, Soren Gam, Kristina Norman, Ursula Müller-Werdan, Wolfram Doehner, Henning Tim Langer","doi":"10.1007/s11897-026-00780-x","DOIUrl":"10.1007/s11897-026-00780-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>This narrative review synthesizes current evidence on lifestyle, pharmacological, surgical, and multimodal interventions targeting muscle strength, body composition, and functional capacity in HFpEF with sarcopenia and/or obesity.</p><p><strong>Recent findings: </strong>Exercise, particularly concurrent endurance and resistance training protocols, improve aerobic capacity, functional performance, symptoms, and quality of life in HFpEF. Protein supplementation may preserve muscle mass, while caloric restriction may enhance aerobic capacity and function butdecreases muscle mass. SGLT2i and GLP-1 medicines may reduce hospitalizations and improve symptoms, with GLP-1 medicines producing greater weight loss and performance benefits. Bariatric surgery may also achieve substantial weight loss and functional improvements, although evidence in HFpEF with obesity is limited. Obesity-related HFpEF may benefit from a combination of resistance exercise and adequate protein intake to preserve muscle during weight loss, while pharmacotherapy can be used to support cardiac function. Future trials should evaluate multimodal interventions to mitigate frailty risk in HFpEF.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Amyloidosis & Advanced Heart Failure: When to Consider Cardiac Transplantation and What are the Results?","authors":"Steven Hamilton, Harsh Patolia, Mazen Hanna","doi":"10.1007/s11897-026-00777-6","DOIUrl":"10.1007/s11897-026-00777-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>The management of end-stage heart failure in cardiac amyloidosis due to both light chain (AL-CA) and transthyretin (ATTR-CA) with heart transplantation has historically been limited by concerns about systemic progression after transplant. As a result, heart transplantation as a strategy was often restrictive and many patients were excluded. This review synthesizes contemporary evidence and outlines a practical framework to guide heart transplant evaluation and decision making in advanced disease. We emphasize evolving multidisciplinary selection principles.</p><p><strong>Recent findings: </strong>In the recent era (since the 2010s), multicenter experience has demonstrated that carefully selected patients with advanced AL-CA and ATTR-CA can achieve favorable outcomes after heart transplantation. Specifically, selected individuals with wild type transthyretin cardiac amyloidosis (ATTRwt-CA) may be appropriate candidates. For hereditary transthyretin cardiac amyloidosis (ATTRv-CA), isolated heart or combined heart liver transplantation (CHLT) can been considered, although modern transthyretin targeted therapies increasingly influence this decision. Patients with AL-CA may undergo transplantation alongside timely plasma cell directed treatment. Historically, outcomes for heart transplantation in patients with cardiac amyloidosis were poor. Improved patient selection as well as advances in plasma cell targeted therapy for AL-CA and transthyretin stabilizing or gene silencing treatments for ATTR-CA have reshaped expectations. The improved outcomes seen in more contemporary cohorts support heart transplantation as a viable option for selected patients with advanced disease.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angela Iurlaro, Myriam Macaluso, Eleonora Meloni, Maria Beatrice Zazzara, Graziano Onder
{"title":"Opioid Use for Dyspnoea in Advanced Heart Failure.","authors":"Angela Iurlaro, Myriam Macaluso, Eleonora Meloni, Maria Beatrice Zazzara, Graziano Onder","doi":"10.1007/s11897-026-00771-y","DOIUrl":"10.1007/s11897-026-00771-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>This narrative review aims to provide an overview of the available evidence on opioid use for refractory dyspnoea in advanced heart failure, focusing on mechanisms, effectiveness, safety, patient selection, and their possible role within a palliative care approach. Evidence from clinical trials and observational studies is presented and practical recommendations about opioid use in patients with refractory dyspnoea in advanced heart failure are provided.</p><p><strong>Recent findings: </strong>Dyspnoea in advanced heart failure is a multidimensional symptom that may persist despite optimal medical therapy. Randomised trials have shown mixed and limited benefits for chronic dyspnoea, while observational studies suggest that opioids can provide clinically relevant short-term relief of refractory dyspnoea in advanced heart failure, with an overall manageable safety profile. In contrast, opioid use in acute heart failure has been associated with worse outcomes. Despite mixed and limited evidence, opioids may be considered for symptom relief in selected patients with advanced heart failure and chronic refractory dyspnoea when used cautiously. Their use should be individualized based on individual patients' characteristics. Opioid use should be avoided in acute heart failure management. Further research is needed to better define patient selection and optimal use.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jorge A Ortega-Hernández, Luca Baldetti, Guglielmo Gallone, Giulio Cacioli, Pier Paolo Bocchino, Gabriela Rojas-Cruz, Raúl Rodrigo Neri-Bale, Antonio Loforte, Jaime Hernández-Montfort
{"title":"Managing Cardiogenic Shock in the Era of Multimodal Mechanical Support: Bridging to Transplant or Recovery.","authors":"Jorge A Ortega-Hernández, Luca Baldetti, Guglielmo Gallone, Giulio Cacioli, Pier Paolo Bocchino, Gabriela Rojas-Cruz, Raúl Rodrigo Neri-Bale, Antonio Loforte, Jaime Hernández-Montfort","doi":"10.1007/s11897-026-00776-7","DOIUrl":"10.1007/s11897-026-00776-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review the contemporary management of cardiogenic shock in the era of multimodal temporary mechanical circulatory support, with emphasis on phenotype-guided device selection, serial trajectory assessment, and bridging toward recovery, durable left ventricular assist device implantation, or heart transplantation.</p><p><strong>Recent findings: </strong>Temporary mechanical circulatory support is now used to influence clinical outcomes, not just as rescue therapy. Devices like intra-aortic balloon pumps, microaxial flow pumps, and venoarterial extracorporeal membrane oxygenation affect heart function and recovery differently; their use should be tailored to the type of ventricular failure and monitored with hemodynamics and imaging. Expanded focus on upper-limb access and prolonged support has broadened temporary support's role in bridging patients to decision, recovery, or transplant. Cardiogenic shock remains a leading cause of mortality in acute myocardial infarction and advanced heart failure despite major advances in temporary mechanical circulatory support. Contemporary outcomes depend not only on device availability, but on matching support intensity to shock phenotype, recognizing trajectory early, minimizing complications, and preserving end-organ function. This review summarizes current evidence on device-specific physiology, escalation and weaning, pulmonary vascular considerations, and post-transplant outcomes, and proposes an integrated framework for individualized, trajectory-based decision-making.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keila C Ostos-Mendoza, Hadi Al Etri, Carlos Manuel Martínez Cerda, Cezar Iliescu, Nicolas L Palaskas
{"title":"Endomyocardial Biopsies in the Diagnostic Workup of Immune Checkpoint Inhibitor Associated Myocarditis.","authors":"Keila C Ostos-Mendoza, Hadi Al Etri, Carlos Manuel Martínez Cerda, Cezar Iliescu, Nicolas L Palaskas","doi":"10.1007/s11897-026-00775-8","DOIUrl":"https://doi.org/10.1007/s11897-026-00775-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>To identify the role of endomyocardial biopsy in the diagnosis, prognostication, and future understanding of mechanisms for immune checkpoint inhibitor myocarditis.</p><p><strong>Recent findings: </strong>The use of endomyocardial biopsy in immune checkpoint inhibitor myocarditis has led to recognizing a spectrum of disease that correlates with mild symptoms to more fulminant presentations. The primary infiltrate observed is CD8+ T cells but more studies are suggesting that the presence of CD68+ macrophages may portend worse prognosis. Currently, endomyocardial biopsy still has a role in diagnosing immune checkpoint inhibitor myocarditis especially when there is uncertainty from non-invasive diagnostic tools. Emerging evidence suggests endomyocardial biopsy can help with prognosis determination and potentially even guide future cancer therapy. Future research into understanding mechanisms of immune checkpoint inhibitor myocarditis will require endomyocardial biopsy for tissue acquisition.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Deactivation of Cardiac Devices at the End of Life: Clinical and Ethical Challenges.","authors":"Marie-Gabrielle Courtès, Fiona Ecarnot, Mathilde Giffard","doi":"10.1007/s11897-026-00772-x","DOIUrl":"10.1007/s11897-026-00772-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>Device deactivation in patients with heart failure is an increasingly relevant clinical and ethical challenge as the use of cardiovascular implantable electronic devices expands.</p><p><strong>Recent findings: </strong>Current guidelines affirm the ethical and legal permissibility of deactivating life-sustaining devices, including implantable cardioverter-defibrillators, pacemakers, and mechanical circulatory support systems, when requested by patients or surrogates with decision-making capacity. Importantly, guidelines from professional societies recommend that discussions about device deactivation be included in the pre-implantation consent process. However, clinical practice reveals persistent gaps in advance care planning, with device deactivation discussions remaining infrequent. Deactivating implantable cardioverter defibrillators can prevent painful and unnecessary shocks at the end of life, which may otherwise prolong dying without improving quality of life. Multidisciplinary involvement, including palliative care consultation, is essential to support patient-centered decision-making and symptom management. This review synthesizes the latest evidence and consensus on device deactivation in heart failure, emphasizing the need for communication, initiated early in the disease course, as well as individualized care, and integration of patient preferences throughout the disease trajectory.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}