ESC Heart Failure最新文献

{"title":"Implementation of guidelines for intravenous iron therapy in heart failure patients","authors":"Milou Gamage,&nbsp;Aristomenis Manouras,&nbsp;Camilla Hage,&nbsp;Gianluigi Savarese,&nbsp;Karin Ljung,&nbsp;Michael Melin","doi":"10.1002/ehf2.15340","DOIUrl":"10.1002/ehf2.15340","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aim to evaluate the implementation of the 2021 ESC Guidelines regarding screening and treatment of iron deficiency in patients with heart failure (HF) at Karolinska University Hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Patients with left ventricular ejection fraction (LVEF) &lt; 50% and New York Heart Association (NYHA) class II–IV who visited Karolinska University Hospital in 2021 were identified through the registry SwedeHF. Data on patient characteristics, screening for iron deficiency, administration of ferric carboxymaltose (FCM) and HF medication were extracted from patients' health records. There were 261 patients registered whereof 141 (54%) were screened. Screened patients had lower LVEF [33% vs. 36% (<i>P</i> = 0.033)], higher N terminal pro brain natriuretic peptide levels [2880 ng/L vs. 1960 ng/L (<i>P</i> = 0.040)], higher prevalence of diabetes [31.9% vs. 20.0% (<i>P</i> = 0.030)] and were more often prescribed sodium-glucose co-transporter 2 inhibitors (SGLT2i) (49.6% vs. 25.8%) and loop diuretics [76.6% vs. 56.7% (both <i>P</i> &lt; 0.001] compared with unscreened patients. Patients treated with intravenous iron had a higher NYHA class than untreated patients with an indication for treatment (<i>P</i> = 0.038).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with HFrEF and HFmrEF, 54% were screened for iron deficiency. Screened patients had more advanced HF disease, possibly due to increased medical attention and higher compliance to guideline recommended treatment. We demonstrate that national quality registries can track outcomes and effectively enhance patient care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3475-3482"},"PeriodicalIF":3.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interconnected pathways and emerging therapies in chronic kidney disease and heart failure: A comprehensive review","authors":"Johann Bauersachs,&nbsp;Eri Toda Kato,&nbsp;Janani Rangaswami","doi":"10.1002/ehf2.15345","DOIUrl":"10.1002/ehf2.15345","url":null,"abstract":"<p>Chronic kidney disease (CKD) and chronic heart failure (HF) frequently coexist and, when comorbid, are associated with poorer outcomes. These two diseases have common risk factors, such as diabetes, obesity and hypertension, and common pathophysiological connected mechanisms, including inflammation, endothelial dysfunction, neurohormonal activation and fibrosis. Early diagnosis and intervention are important to slow CKD progression and reduce HF events. Shared therapeutic targets for CKD and HF include the renin–angiotensin system (RAS), sodium-glucose cotransporter 2 (SGLT2), mineralocorticoid receptor (MR) and glucagon-like peptide-1 (GLP-1) receptor. For the management of CKD, current treatment guidelines recommend the use of RAS inhibitors, SGLT2 inhibitors, the nonsteroidal MR antagonist finerenone and GLP-1 receptor agonists. Challenges in the management of patients with CKD and HF include the presence of other comorbidities, leading to polypharmacy. This review highlights gaps and opportunities for improving the management of patients with CKD and chronic HF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3226-3249"},"PeriodicalIF":3.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HEART Camp Connect—Promoting adherence to exercise in adults with heart failure with preserved ejection fraction","authors":"Windy W. Alonso,&nbsp;Sara E. Bills,&nbsp;Scott W. Lundgren,&nbsp;Steven J. Keteyian,&nbsp;Joseph Norman,&nbsp;Alfred L. Fisher,&nbsp;Cheng Zheng,&nbsp;Kevin A. Kupzyk,&nbsp;Fernando A. Wilson,&nbsp;Tiffany J. Dudley,&nbsp;Bunny J. Pozehl","doi":"10.1002/ehf2.15341","DOIUrl":"10.1002/ehf2.15341","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Most adults with stable heart failure are safe to exercise at a moderate intensity for 150 min/week. Regular participation in exercise may improve outcomes in adults with heart failure with preserved ejection fraction (HFpEF). Few adults with HFpEF initiate and sustain long-term exercise. To promote exercise adherence in adults with HFpEF, we developed the Heart Failure Exercise and Resistance Training (HEART) Camp Connect intervention that is tested in this clinical trial. This trial tests our central hypothesis that theory-informed coaching strategies delivered virtually will promote long-term adherence to exercise in adults with HFpEF and drive clinically meaningful, and cost-effective improvements in physiological and patient-reported outcomes. Our aims are to (a) evaluate the effects of virtual and in-person exercise and coaching on long-term adherence, (b) determine a benchmark of minutes of moderate intensity exercise associated with health status as related to key biobehavioural outcomes, (c) examine behaviour change theory-defined constructs as mediators of exercise adherence and (d) evaluate intervention costs.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This 18 month, three-group, repeated measures randomized controlled trial is enrolling 300 adults with HFpEF. Participants are randomized to enhanced usual care (EUC), virtual coaching, or in-person coaching. Our intervention applies coaching strategies, informed by behaviour change theories, in one-on-one and group settings weekly for 12 months. Our objective is to compare the effects of each delivery method to the other and EUC on exercise adherence (defined as ≥ 120 min of moderate intensity exercise/week) at 12 months (primary endpoint) and 18 months (sustainability endpoint). Secondary outcomes include minutes of moderate intensity exercise needed to drive minimal clinically important differences in health status, biomarkers, patient-reported symptoms and cost. Behaviour change theory-defined constructs (e.g., self-efficacy and outcome expectations) will be tested as mediators of exercise adherence.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We expect that virtual coaching is equally as efficacious and more cost effective at promoting exercise adherence as in-person coaching. Effects on exercise adherence may be mediated by theory-defined constructs. We also expect to identify a threshold for minutes of moderate intensity exercise to potentially serve as an adherence benchmark in adults with HFpEF, one that may differ from the 120 min of exercise in our current definition.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 ","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3388-3398"},"PeriodicalIF":3.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15341","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification, characterisation and outcomes of pre-atrial fibrillation in heart failure with reduced ejection fraction","authors":"Anna Helbitz,&nbsp;Ramesh Nadarajah,&nbsp;Lan Mu,&nbsp;Harriet Larvin,&nbsp;Hesham Ismail,&nbsp;Ali Wahab,&nbsp;Patrick Thompson,&nbsp;Peter Harrison,&nbsp;Mohammad Harris,&nbsp;Tobin Joseph,&nbsp;Sven Plein,&nbsp;Mark Petrie,&nbsp;Marco Metra,&nbsp;Jianhua Wu,&nbsp;Peter Swoboda,&nbsp;Chris P. Gale","doi":"10.1002/ehf2.15347","DOIUrl":"10.1002/ehf2.15347","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) in heart failure with reduced ejection fraction (HFrEF) has prognostic implications. Using a machine learning algorithm (FIND-AF), we aimed to explore clinical events and the cardiac magnetic resonance (CMR) characteristics of the pre-AF phenotype in HFrEF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>A cohort of individuals aged ≥18 years with HFrEF without AF from the MATCH 1 and MATCH 2 studies (2018–2024) stratified by FIND-AF score. All received cardiac magnetic resonance using Cvi42 software for volumetric and T1/T2. The primary outcome was time to a composite of MACE inclusive of heart failure hospitalisation, myocardial infarction, stroke and all-cause mortality. Secondary outcomes included the association between CMR findings and FIND-AF score. Of 385 patients [mean age 61.7 (12.6) years, 39.0% women] with a median 2.5 years follow-up, the primary outcome occurred in 58 (30.2%) patients in the high FIND-AF risk group and 23 (11.9%) in the low FIND-AF risk group (hazard ratio 3.25, 95% CI 2.00–5.28, <i>P</i> &lt; 0.001). Higher FIND-AF score was associated with higher indexed left ventricular mass (β = 4.7, 95% CI 0.5–8.9), indexed left atrial volume (β = 5.9, 95% CI 2.2–9.6), higher indexed left ventricular end-diastolic volume (β = 9.55, 95% CI 1.37–17.74, <i>P</i> = 0.022), native T1 signal (β = 18.0, 95% CI 7.0–29.1) and extracellular volume (β = 1.6, 95% CI 0.6–2.5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A pre-AF HFrEF subgroup with distinct CMR characteristics and poor prognosis may be identified, potentially guiding interventions to reduce clinical events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3688-3696"},"PeriodicalIF":3.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15347","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic stenosis intricacies beyond the valve: A bidirectional Mendelian randomization study","authors":"Dihui Cai,&nbsp;Jianhui Liu","doi":"10.1002/ehf2.15348","DOIUrl":"10.1002/ehf2.15348","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Numerous observational studies have reported an association between calcific aortic valve stenosis (CAVS) and an increased risk of other cardiovascular diseases (CVDs). However, the potential causal association is uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>A bidirectional Mendelian randomization (MR) analysis was performed to confirm the causal association between CAVS and the risk of seven common CVDs. The meta-analysis was used to estimate the combined causal effect with multiple MR results. The MR analysis indicated that genetically predicted CAVS is associated with the increased risk of heart failure (odds ratio [OR] = 1.064; 95% confidence interval [CI] [1.008, 1.123]; <i>P</i> = 0.025), large-artery stroke (OR = 1.256; 95% CI [1.112, 1.418]; <i>P</i> &lt; 0.001), cardioembolic stroke (OR = 1.228; 95% CI [1.117, 1.349]; <i>P</i> &lt; 0.001) and atrial fibrillation (OR = 1.100; 95% CI [1.061, 1.140]; <i>P</i> &lt; 0.001) without heterogeneity and pleiotropy. Genetically predicted hypertension (FinnGen: OR = 1.170; 95% CI [1.055, 1.297]; <i>P</i> = 0.003 and UK Biobank: OR = 2.456; 95% CI: 1.571, 3.840; <i>P</i> = 8.16 × 10⁻⁵) increased the risk of CAVS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This comprehensive MR study revealed the causal relationship between genetically predicted CAVS and the increased risk of various CVDs and the causal relationship between hypertension and CAVS risk. Given the harmful causal impact of CAVS on adverse cardiovascular events, it is crucial to prioritize the prevention and management of CVD in individuals with CAVS. Blood pressure management is an effective preventive intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3276-3284"},"PeriodicalIF":3.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15348","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial fibrillation and flutter as global drivers of heart failure: Burden and longitudinal trends over three decades","authors":"Yabin Liu,&nbsp;Jingsi Duan,&nbsp;Yue Wang,&nbsp;Nicola Luigi Bragazzi,&nbsp;Mengying Huang,&nbsp;Huimin Chen,&nbsp;Haijiang Dai,&nbsp;Cheng Ni","doi":"10.1002/ehf2.15344","DOIUrl":"10.1002/ehf2.15344","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The study aims to comprehensively evaluate the global burden of heart failure attributable to atrial fibrillation (AF) and atrial flutter (AFL) from 1990 to 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from the Global Burden of Disease Study 2021, we estimated the prevalence and years lived with disability (YLDs) of heart failure attributable to AF/AFL across 204 countries and territories. Estimates were stratified by age, sex and socio-demographic index (SDI). Age-standardized rates per 100 000 population were calculated, and percentage changes between 1990 and 2021 were analysed to assess temporal trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2021, AF/AFL were responsible for an estimated 714 137.5 [95% uncertainty interval (UI) 520 543.5 to 940 900.6] heart failure cases and 63 942.8 (95% UI 39 057.9 to 96 196.5) YLDs globally. The age-standardized prevalence and YLD rates were 8.85 (95% UI 6.38 to 11.63) and 0.79 (95% UI 0.49 to 1.19) per 100 000 population, respectively. Between 1990 and 2021, global absolute numbers of heart failure cases and YLDs attributable to AF/AFL increased by 339.3% (95% UI 292.7 to 387.0) and 337.5% (95% UI 290.1 to 387.0), respectively. Age-standardized prevalence and YLD rates increased by 65.2% (95% UI 47.7 to 83.8) and 65.4% (95% UI 46.6 to 83.5), respectively. The burden progressively increased with age, peaking among individuals aged ≥95 years. Females experienced a higher burden than males from age 55 years onward, with the greatest disparity observed in the 85–89 years age group. High SDI regions, such as Australasia and Western Europe, exhibited the highest prevalence and YLD rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The global burden of heart failure attributable to AF/AFL increased substantially from 1990 to 2021, disproportionately affecting older adults, females aged 55 years and above and populations in high SDI regions. These findings highlight the urgent need for targeted interventions and resource allocation to address the growing challenges, particularly for vulnerable groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3697-3706"},"PeriodicalIF":3.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15344","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proteins associated with rehospitalization, mortality and diuretic resistance in acutely decompensated heart failure","authors":"Kenneth T. Hubbell,&nbsp;Veena S. Rao,&nbsp;Rebecca Scherzer,&nbsp;Michael G. Shlipak,&nbsp;Juan B. Ivery-Miranda,&nbsp;Nisha Bansal,&nbsp;Zachary L. Cox,&nbsp;Jeffrey M. Testani,&nbsp;Michelle M. Estrella","doi":"10.1002/ehf2.15342","DOIUrl":"10.1002/ehf2.15342","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Most proteomic analyses in patients with heart failure (HF) focus on the stable ambulatory setting; pathways that drive acute decompensated heart failure (ADHF) are largely uncharacterized. We aimed to examine the associations of cardiometabolic proteins with HF rehospitalization, mortality and diuretic response in patients with ADHF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Mechanisms of Diuretic Resistance Cohort comprised patients hospitalized for ADHF at Yale New Haven Hospital from 2015 to 2020. We quantified 369 serum proteins and evaluated their associations with rehospitalization, mortality or diuretic response, using individual and combined biomarkers. Models adjusted for sociodemographic/lifestyle factors, comorbidities and clinical factors. For individual biomarker models, significant proteins were those with a false-discovery rate <i>q</i>-value (FDRq) &lt;1%, while combined biomarker models used a penalized cross-validated log-likelihood method to reduce false positives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 401 patients enrolled, median age was 65 years; 36% were female. Six (C1QTNF1, CTSD, FCN2, SERPINA12, TFRC and TNFRSF10C) were associated with increased risk of HF rehospitalization [hazard ratio (HR) ranging from 1.2 to 1.35 per standard deviation (<i>SD</i>) protein concentration] while one (SDC1) was associated with decreased risk (HR = 0.77 per <i>SD</i> protein concentration). Three (CDH1, FABP6 and TNC) were associated with mortality (HR ranging from 1.35 to 1.64 per <i>SD</i> protein concentration). Three (MMP7, PGLYRP1 and REN) were associated with reduced diuretic response (% Estimate ranging from −12.2% to −18.6% per <i>SD</i> protein concentration). Among all proteins, those associated with lower diuretic response correlated with greater mortality risk [Spearman <i>r</i> = −0.63 (95% confidence interval: −0.56, −0.69)].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Several proteins with known associations with cardiometabolic disease were associated with poor outcomes or reduced diuretic response. They have known roles in inflammatory, metabolic and cardiac or kidney remodelling pathways and may point to novel pathways in ADHF that warrant investigation as potential prognostic tools and targets for intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3296-3305"},"PeriodicalIF":3.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15342","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization of renin-angiotensin-aldosterone inhibitor therapies for evidence-based indications: a call to action from the cardio-kidney community","authors":"Roberto Pecoits-Filho,&nbsp;Michelle M.Y. Wong,&nbsp;Monica Moorthy,&nbsp;Debasish Banerjee,&nbsp;Suman Behera,&nbsp;Viviane Calice-Silva,&nbsp;Mogamat-Yazied Chothia,&nbsp;Gates B. Colbert,&nbsp;Martha Gulati,&nbsp;Charles A. Herzog,&nbsp;Fadi Jouhra,&nbsp;Edgar V. Lerma,&nbsp;Charu Malik,&nbsp;Kershaw V. Patel,&nbsp;Amina Rakisheva,&nbsp;Giuseppe M.C. Rosano,&nbsp;Priyanka Satish,&nbsp;Henry H.L. Wu,&nbsp;Angela Yee-Moon Wang","doi":"10.1002/ehf2.15262","DOIUrl":"10.1002/ehf2.15262","url":null,"abstract":"&lt;p&gt;Renin–angiotensin–aldosterone system inhibitor (RAASi) therapy, including angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNi), and steroidal and non-steroidal mineralocorticoid receptor antagonists (MRAs), is essential for treating diabetic and non-diabetic chronic kidney disease (CKD), heart failure (HF), and hypertension (HTN). However, these medications can lead to adverse events such as acute kidney injury and hyperkalemia. When patients experience these adverse events, RAASi therapy is often modified or stopped, potentially resulting in worse cardiovascular and kidney outcomes.&lt;/p&gt;&lt;p&gt;To manage patients effectively in this scenario, it is crucial to find a balance between the risks and benefits of RAASi therapy. This commentary reviews the evidence supporting the benefit/risk profile of RAASi in patients at the intersection of kidney and cardiovascular medicine, aiming to offer guidance for optimizing RAASi therapy in clinical practice. Additionally, a multi-stakeholder initiative is introduced to support healthcare professionals in implementing optimal RAASi therapy.&lt;/p&gt;&lt;p&gt;Given its strong evidence base, RAASi therapy is embedded in the guidelines for management of diabetes, CKD, HF, and HTN (&lt;i&gt;Table&lt;/i&gt; 1).&lt;span&gt;&lt;sup&gt;1-5&lt;/sup&gt;&lt;/span&gt; For patients with CKD, ACEi/ARB and non-steroidal MRA therapy decreases albuminuria, and risks of mortality, cardiovascular (CV) events, and progression to kidney failure (KF).&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; Because the albuminuria-reducing effect is dose-related, guidelines recommend titration of ACEi or ARB to maximum approved doses or highest tolerated doses.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In patients with CKD and estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;, steroidal MRAs in combination with ACEi or ARB reduce proteinuria and blood pressure, but there are uncertain effects on major CV and KF events due to limited data in trials.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; The addition of the non-steroidal MRA, finerenone, on top of ACEi/ARB reduced the rate of both KF and CV events in patients with CKD with a satisfactory safety profile. In patients with HF with reduced ejection fraction (HFrEF), ACEi/ARB/ARNi, and steroidal MRAs have demonstrated benefits for mortality and HF hospitalization outcomes, and along with beta-blockers and sodium-glucose co-transporter 2 (SGLT-2) inhibitors, comprise the four pillars of guideline-directed medical therapy for HFrEF.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In everyday practice, the dosing and maintenance of RAASi is suboptimal, with only approximately 25–45% of patients reaching target dosing.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; Additionally more than 10% of patients may have their RAASi therapy discontinued altogether, particularly those at the lower range of eGFR. In the specific setting of HF, 27%, and 67% were not prescribed ACEi/ARB/ARNi, and MRA therapy, respectively.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2597-2604"},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-admission beta-blocker therapy and outcomes in cardiogenic shock: Insights from the Altshock-2 Registry","authors":"Matteo Pagnesi,&nbsp;Mauro Riccardi,&nbsp;Alice Sacco,&nbsp;Giovanni Tavecchia,&nbsp;Giovanna Viola,&nbsp;Simone Frea,&nbsp;Martina Briani,&nbsp;Letizia Fausta Bertoldi,&nbsp;Maurizio Bertaina,&nbsp;Luciano Potena,&nbsp;Serafina Valente,&nbsp;Marco Marini,&nbsp;Gaetano Maria De Ferrari,&nbsp;Nicoletta D'Ettore,&nbsp;Astrid Cardinale,&nbsp;Rita Camporotondo,&nbsp;Matteo Rota,&nbsp;Guido Tavazzi,&nbsp;Nuccia Morici,&nbsp;Federico Pappalardo,&nbsp;Marco Metra,&nbsp;Altshock-2 investigators","doi":"10.1002/ehf2.15322","DOIUrl":"10.1002/ehf2.15322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aimed to assess the impact of pre-admission beta-blocker (BB) therapy on the clinical characteristics, in-hospital treatment and outcomes of patients with cardiogenic shock (CS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients enrolled in the multicentre prospective Altshock-2 registry since March 2020 with available data on pre-admission BB therapy were included. Clinical characteristics, in-hospital management, haemodynamic parameters and clinical outcomes were compared in patients with versus without BB therapy. The primary endpoint was in-hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 668 patients were included [median age 66 (56–74) years, male sex 76.5%]: 299 patients (44.8%) with and 369 patients (55.2%) without previous BB therapy. Patients receiving pre-admission BB therapy had more frequently heart failure-related CS (43.8% vs. 17.9%) and less frequently cardiac arrest at presentation (20.1% vs. 27.8%, <i>P</i> = 0.027). Levosimendan was used less frequently and dobutamine was used more frequently in patients with baseline BB therapy (<i>P</i> = 0.033 and <i>P</i> = 0.043, respectively). Differences in the early haemodynamic response to vasoactive drugs were observed between patients with and without previous BB therapy, with a significant impact of baseline BB on mean arterial pressure (MAP) response during norepinephrine infusion (<i>P</i> = 0.012) and with dobutamine having a reduced response in MAP and heart rate in patients receiving BBs before admission (<i>P</i> = 0.023 and <i>P</i> = 0.001, respectively). In-hospital mortality was not significantly different between the BB and no-BB groups (40% vs. 33.7%; adjusted odds ratio 1.32, 95% confidence interval 0.84–2.07, <i>P</i> = 0.224). Similarly, baseline BB therapy was not independently associated with 48 h mortality (12.7% vs. 14.6%; adjusted odds ratio 1.09, 95% confidence interval 0.64–1.87, <i>P</i> = 0.749). The lack of association between baseline BB therapy and mortality was also confirmed at inverse probability of treatment weighting-adjusted analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a real-world, contemporary cohort of patients with CS, previous BB therapy influenced the haemodynamic response to vasoactive drugs, but it was not associated with in-hospital mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2565-2577"},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15322","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short report: Hospitalization for new-onset heart failure in survivors of hospitalized COVID-19","authors":"Vicente Corrales-Medina,&nbsp;Jordana B. Cohen,&nbsp;Seavmeiyin Kun,&nbsp;Bianca Pourmussa,&nbsp;Ozgun Erten,&nbsp;Joe-David Azzo,&nbsp;Julio A. Chirinos","doi":"10.1002/ehf2.15331","DOIUrl":"10.1002/ehf2.15331","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Previous studies have reported an incidence of new-onset heart failure (HF) among COVID-19 survivors ranging from 0.7 to 8.5 per 100 person-years, but they relied on administrative data for outcome ascertainment. Given the public health implications, a more accurate characterization of the HF burden post-COVID-19 is important.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We conducted a prospective cohort study of survivors of hospitalized COVID-19 and tracked the incidence of new-onset HF hospitalizations over the 12-month period following the index COVID-19 episode. Outcome ascertainment was based on a combination of chart reviews, patient interviews, and pre-specified clinical, radiographic and laboratory criteria. We identified 2140 survivors of COVID-19 hospitalization that were free of HF at the time of discharge. Their mean age was 67 years and 48% were Black/African-Americans. The incidence rate of hospitalized new-onset HF was 0.5 per 100 person-years. Higher BMI and dialysis dependency at baseline were significantly associated with HF development. The 1-year mortality rate was 3%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The incidence of new-onset HF post-COVID-19 in our study was lower than in previous reports, despite involving an older population with more comorbidities and/or more severe COVID-19 overall. Reliance on administrative data for outcome adjudication in prior studies may have led to an overestimation of the HF burden post-COVID-19.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3073-3078"},"PeriodicalIF":3.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}