搜索结果：Heart failure reviews

Heart failure prevalence is increasing and has a disproportionate burden on older adults. Older adults, however, may encounter unique challenges in accessing and navigating comprehensive disease-modifying, guideline-directed therapies, thus limiting use among those at highest risk of cardiovascular death or worsening heart failure. Care of the older adult with heart failure requires tailored treatment plans to overcome barriers to effective therapies in this population. This scientific statement reviews the literature on care optimization for older adults (≥65 years of age) living with heart failure and highlights strategies for clinicians who aim to deliver patient-centered, evidenced-based heart failure care in the context of common comorbidities seen in older adults. We discuss the consistent treatment effect and safety profiles of guideline-directed therapies for heart failure in older adults and how to manage multimorbidity, polypharmacy, frailty, and social needs using a shared decision-making framework. In consideration of the complexity of heart failure care of the older adult, we highlight a structured framework for therapeutic considerations in the context of benefit-to-risk ratio, multimorbidity, and social needs. We offer practical guidance on the care of older adults with advanced comorbidities who may not have been adequately represented in landmark trials. We also consider implementation strategies, health services interventions, and supportive tools that may foster optimal care in older adults with heart failure. This work is aimed at informing the practice of clinicians and health systems alike to improve outcomes and to reduce the morbidity of heart failure in older adults.

Social frailty is increasingly recognised among people living with heart failure and is linked to a range of clinical and psychosocial risk factors, with significant implications for health outcomes. However, inconsistencies in the conceptualisation and measurement of social frailty, coupled with a lack of systematic reviews, hinder evidence synthesis and the development of targeted interventions. This scoping review aimed to map current evidence on the definition, measurement tools, prevalence, associated factors and health-related outcomes of social frailty in individuals with heart failure. Following the PRISMA-ScR guidelines, a comprehensive electronic search was conducted in June 2025 across eight databases: Web of Science, PubMed, CINAHL Complete, Scopus, Embase, Cochrane, CNKI and Wanfang. Search terms were guided by the Population-Concept-Context mnemonic, focusing on heart failure, social frailty, and healthcare or community settings and in accordance with the aim of the review. A total of 27 articles were included. No unified definition of social frailty was identified, and existing assessment tools exhibited heterogeneity. Prevalence rates varied widely across settings and measurement tools. Factors associated with social frailty included sociodemographic characteristics, socioeconomic status, clinical severity, psychological status and contextual factors. Social frailty was consistently linked to adverse outcomes such as diminished quality of life, increased rehospitalisation risk and higher mortality. The current literature highlights significant conceptual and methodological gaps in understanding social frailty in heart failure. Standardised definitions, validated assessment tools and deeper exploration of underlying mechanisms are needed to guide effective interventions and improve holistic care for people living with heart failure. Routine assessment of social frailty, including living arrangements, perceived social support and social participation, may facilitate the early identification of older people with heart failure who are at increased clinical and social risk. Identification of social frailty may help uncover unmet social needs and facilitate timely referral to social and community resources. As coordinators of holistic care, nurses can promote multidisciplinary collaboration and support tailored interventions that address both symptom burden and social functioning, thereby helping to reduce functional limitations and social isolation. Technology-enabled approaches, such as digital health platforms, care robots and interactive tools, may provide additional opportunities to enhance social engagement, improve access to care and promote more holistic and person-centred heart failure management.

Heart failure leads to adverse clinical and patient-reported outcomes. Its prevalence has increased markedly among adults aged 60 years and over. Transitional care interventions are recommended to address these issues; however, their effectiveness on health outcomes, particularly in older adults, remains limited and inconclusive. This study aimed to systematically review and synthesise the existing evidence from randomised controlled trials on the effectiveness of transitional care interventions on health outcomes among older adults with heart failure. Only randomised controlled trials were included. This systematic review and meta-analysis were conducted according to the Cochrane Collaboration methodology and were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies from 2001 to the present were identified through searches of PubMed, the Cochrane Library, Web of Science Core Collection, and Cumulative Index to Nursing and Allied Health Literature Plus with full text. Risk ratios, mean differences, and standardised mean differences were calculated. Heterogeneity was evaluated with the I2 statistic. The certainty of the evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation criteria. Eight studies with 967 subjects (483 in the intervention group and 484 in the control group) were included in this systematic review and meta-analysis. Transitional care interventions were associated with improvements in self-care confidence and reductions in heart failure-specific readmission. There were no statistically significant effects on self-care maintenance, self-care management, or heart failure knowledge. Findings for health-related quality of life, functional status, and event-free survival varied across studies. The certainty of the evidence ranged from very low to moderate. Transitional care interventions were associated with improved self-care confidence and reduced heart failure-specific readmissions in older adults with heart failure. However, variations in the certainty of the evidence create uncertainty about the intervention's effect. The limited number of trials included in this review demonstrates an evidence gap in this area. Further high-quality studies with transparent reporting through prospective trial registration should be conducted to determine the optimal content of the transitional care intervention. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021229464). Not applicable.

This project evaluated telehomecare technologies in the management of heart failure, with a focus on comparing invasive and noninvasive devices and impact on clinical outcomes, hospitalizations, and patient self-management. A literature review was conducted using PubMed to identify studies published in adults between 2015 and 2024 that examined telehomecare and telemonitoring interventions in heart failure. Search terms included telehealth, telehomecare, telemonitoring, and heart failure. Eligible studies included randomized controlled trials, observational studies, systematic reviews, and meta-analyses evaluating both invasive and noninvasive technologies. Across the reviewed studies, several invasive and noninvasive telehomecare interventions were identified that were associated with improvements in clinical and patient-centered outcomes. Remote monitoring enabled earlier detection of clinical deterioration, reduced all-cause and heart failure-related hospitalizations, and enhanced patient engagement and self-management. Benefits were greatest when monitoring tools were used consistently, integrated into structured care programs, and supported by timely clinical follow-up. Telehomecare represents an effective and patient-centered approach to heart failure management. Invasive monitoring devices provide strong evidence and benefits for high-risk patients through continuous physiologic assessment, while noninvasive tools offer accessible solutions for daily monitoring and self-management. When incorporated into coordinated care models, telehomecare improves outcomes and reduces the burden of heart failure.

The management of AF in patients with heart failure is complex and nuanced. This paper explores the potential antiarrhythmic effects of guideline-directed medical therapy for heart failure and reviews the pharmacological and ablative treatments for AF. Heart failure with reduced ejection fraction is discussed separately from heart failure with preserved ejection fraction. Treatment recommendations for each heart failure subtype are given.

Acute heart failure often leads to impaired physical function, high rehospitalization rates, and poor quality of life. Although exercise-based rehabilitation benefits chronic heart failure patients, its feasibility in acute heart failure is limited. Neuromuscular electrical stimulation offers a potential alternative by safely inducing muscle contractions without causing dyspnea. The protocol was registered with the International Prospective Register of Systematic Reviews (registration number CRD42023453116). Following PRISMA guidelines, a comprehensive search of PubMed, Cochrane Library, and Embase was conducted up to October 13, 2025. Randomized controlled trials comparing neuromuscular electrical stimulation to control treatments in patients with acute heart failure were included. Data synthesis was performed using Review Manager 5.4. Seven randomized controlled trials, with methodological quality ranging from fair to excellent (Physiotherapy Evidence Database (PEDro) scores 5-9), were included. Pooled data analysis revealed that neuromuscular electrical stimulation significantly improved 6-min walking distance (mean difference = 69.92 m, 95% confidence interval CI [32.17-1 07.68], p = 0.0003), quality of life (standardized mean difference = 1.53, 95% CI [1.03-2.03], p < 0.00001), and showed preliminary evidence of improvement in leg muscle strength (standardized mean difference = 0.77, 95% CI [0.25-1.29], p = 0.004), whereas no significant difference was observed in left ventricular ejection fraction (mean difference = 1.94%, 95% CI [-3.91 to 7.79], p = 0.52). Neuromuscular electrical stimulation was generally well tolerated, with no serious adverse events directly attributable to the intervention. Neuromuscular electrical stimulation was noted to be effective for improving physical capacity and quality of life in patients with acute heart failure. It offers a promising option for patients unable to engage in conventional rehabilitation. Further large-scale, multicenter Randomized Controlled Trials (RCTs) are needed to confirm these findings.

Heart failure is a long-term progressive disease affecting millions of people worldwide, imposing physical, psychological, and social burdens on patients and their families. Symptom recognition, which refers to awareness and understanding of bodily changes, is a key aspect of self-care; however, how patients and their families live with symptoms and deal with them in their daily lives remains unclear. This review aimed to summarise the current knowledge on how patients with heart failure and their caregivers experience, notice, and manage symptoms in daily life, and to identify the knowledge gaps that make timely and appropriate care difficult. This scoping review followed the frameworks of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Four databases (PubMed, CINAHL, PsycINFO, and Ichushi-Web) were searched for peer-reviewed studies published between 2010 and 2025. Studies focusing on the symptom experiences of adult patients with heart failure and their caregivers were included. Two reviewers independently screened and extracted the data, which were organised into main themes. Of the 2,057 studies, 19 were included (14 qualitative, three cross-sectional, and two mixed-method). Findings were grouped into five categories: symptom experiences, in which breathlessness, tiredness, and swelling were often accepted as normal; detection and barriers, in which vague or small changes were often missed; family and caregiver roles, in which families sometimes encouraged early care-seeking but sometimes delayed it; management factors, including cognition, family support, healthcare complexity, and treatment burden; and knowledge and system gaps, including low body awareness, delays in severe cases, and limited attention to contextual factors. Managing heart failure symptoms depends not only on medical knowledge but also on psychological, social, and contextual factors. Interventions should go beyond education by correcting normalisation, reducing the treatment burden, and combining human support with technology. Building multilayered strategies that link knowledge and action is essential for reducing readmissions and improving quality of life.

A key limitation in contemporary HF management is the marked heterogeneity of the syndrome, driven by diverse pathophysiological mechanisms that are not fully captured by traditional classifications based on left ventricular ejection fraction. Precision medicine has emerged as a promising approach to address this heterogeneity by integrating clinical characteristics, circulating biomarkers, advanced imaging, and computational phenotyping strategies. However, current frameworks predominantly emphasize myocardial dysfunction, while the contribution of vascular abnormalities remains underrepresented. The interaction between the left ventricle and the arterial system plays a fundamental role in cardiovascular performance. Arterial stiffness, commonly assessed by pulse wave velocity (PWV), represents a key determinant of vascular aging and a robust predictor of cardiovascular risk. Increasing evidence suggests that vascular dysfunction contributes significantly to the pathophysiology and clinical expression of HF, particularly in phenotypes characterized by preserved ejection fraction. This review synthesizes current evidence on precision medicine in HF and highlights the emerging role of arterial stiffness and PWV in multidimensional patient phenotyping. We propose that integrating vascular parameters into existing phenotyping frameworks may enhance risk stratification, improve mechanistic understanding, and support the development of more personalized therapeutic strategies in heart failure. Unlike previous reviews that have addressed arterial stiffness or heart failure phenotyping separately, this work uniquely integrates ventricular-vascular interaction and pulse wave velocity into a comprehensive precision medicine framework for heart failure. By bridging vascular physiology with data-driven phenotyping strategies, this review provides a novel conceptual model for incorporating arterial stiffness into multidimensional patient characterization across the full spectrum of heart failure phenotypes.

The purpose of this study was to evaluate the impact of pharmacist-led interventions on sodium-glucose cotransporter-2 inhibitor (SGLT2i) prescribing in hospitalized patients with heart failure with reduced ejection fraction (HFrEF). A quality improvement study was conducted at an academic medical center with 2 phases: a retrospective medication-use evaluation (phase I) and a prospective intervention period (phase II). Phase I assessed eligibility for SGLT2i initiation in hospitalized patients with HFrEF without active study intervention. In phase II, interdisciplinary education on the benefits and place in therapy of SGLT2i was provided. A pharmacist routinely reviewed electronic health records to identify patients eligible for SGLT2i and recommended therapy initiation. The primary endpoint of the study was the percentage of eligible patients on an SGLT2i before and after implementation of pharmacist intervention. Secondary endpoints included 30-day all-cause and heart failure readmission rates, the quantity and acceptance rate of pharmacist interventions, and the incidence of adverse outcomes. Among 150 patients in phase I and 133 patients in phase II, 123 and 94 were eligible for SGLT2i therapy, respectively. The overall frequency of inpatient SGLT2i prescribing significantly increased from phase I to phase II (38.2% vs 68.1%, respectively; P < 0.001). Continuation of outpatient SGLT2i therapy during hospitalization also improved after implementation of pharmacist intervention (from 16.3% to 36.2%; P = 0.001). There were no differences in readmission rates or the incidence of adverse events. The acceptance rate for pharmacist interventions was 50%. Increased prescribing of SGLT2i therapy in hospitalized patients with heart failure was observed following pharmacist-led education and prospective reviews with feedback.

The COVID-19 pandemic and related non-pharmaceutical interventions (NPIs) (e.g., lockdowns and contact restrictions) disrupted routine healthcare delivery. In Germany, these measures affected diagnostic and treatment services for people with cancer and cardiovascular diseases, potentially delaying diagnosis and adversely influencing outcomes. We assessed whether and to what extent diagnosis, health utilization and health outcome among patients with selected cancer and cardiovascular conditions changed in Germany during the pandemic. We conducted two systematic reviews of studies from Germany on selected cancers (breast, lung and pancreatic) and cardiovascular conditions (atrial fibrillation/flutter, heart failure, hypertensive and chronic ischemic heart disease). Protocols were registered in PROSPERO and the reviews were reported in accordance with PRISMA. We searched PubMed, Web of Science, Cochrane Library, Scopus, and Embase and screened grey literature. Outcomes included changes in new diagnoses, healthcare utilization, treatment, and disease-specific mortality during the pandemic (2020-2023) compared with the pre-pandemic period (2018-2019). Two reviewers independently screened records, extracted data, and assessed risk of bias using an adapted ROBINS-E tool. Owing to heterogeneity, we synthesized findings narratively. We screened 1991 records for cancer and 4,981 records for cardiovascular diseases, and included 9 cancer studies and 10 cardiovascular studies. For cancer, several studies reported a relative reduction in new breast and lung cancer diagnoses of up to 25% during lockdown periods; hospital admissions decreased by up to 9%. For cardiovascular conditions, hospital admissions for atrial fibrillation/flutter and heart failure decreased by up to 20%, particularly during pandemic peaks. Evidence on treatment delays, changes in treatment, and mortality was limited, and outcomes for other included diagnoses were often not reported. The available evidence indicates substantial reductions in hospital admissions and new diagnoses among patients with cancer and cardiovascular disease in Germany during the pandemic, suggesting major disruptions to care delivery. However, heterogeneity and gaps in the evidence base limit a comprehensive assessment of downstream outcomes. More comprehensive, linked data and further research are needed to quantify the full pandemic's impact and to strengthen health-system resilience for future crises.

Heart failure (HF) in the pediatric population is unique because it involves heterogeneous groups of diseases, including congenital and acquired conditions. The etiology of HF varies with age and sociodemographic origin. In low-income countries, unoperated congenital heart diseases are common, leading to a high prevalence of infants with HF and older children with Eisenmenger syndrome. In addition, rheumatic heart diseases are prevalent, leading to advanced HF in children. Infectious diseases such as tuberculosis and schistosomiasis add to the burden of heart diseases through complications, including pericarditis and pulmonary hypertension. In tropical regions, cardiomyopathies (e.g., endomyocardial fibrosis) have unique causes that have been linked to tropical parasitic infections. The management of pediatric HF is constrained by challenges such as late diagnosis and poor access to medical and interventional therapies. Point-of-care ultrasound holds promise for improving early diagnosis, but appropriate training is required for its use. This study reviews the diagnosis and management of HF, with an emphasis on the limitations encountered in low-resource settings.

Cardio-metabolic-renal (CMR) conditions, including type 2 diabetes mellitus, cardiovascular disease and chronic kidney disease, represent some of the most pressing public health challenges of the 21st century. In recent years, sodium-glucose co-transporter 2 (SGLT2) inhibitors (SGLT2is) have emerged as promising therapeutic agents across these interconnected disease areas. In Europe, the four currently approved SGLT2is for the treatment of type 2 diabetes mellitus - dapagliflozin, empagliflozin, canagliflozin and ertugliflozin - all have demonstrated cardiovascular and renal benefits in large cardiovascular outcomes trials. Notably, empagliflozin and dapagliflozin have also received approval for the treatment of heart failure and chronic kidney disease. This narrative review provides an overview of the role of SGLT2is in the management of CMR diseases. Overall, SGLT2is have demonstrated consistent cardiovascular safety and clinically meaningful benefits in selected outcomes across CMR conditions, with variations amongst individual agents reflecting differences in trial populations, study design and approved indications. This review summarizes current evidence to support individualized therapeutic decision-making rather than comparative positioning within the class. People with type 2 diabetes mellitus often develop other serious health problems over time. These include heart disease, heart failure and chronic kidney disease. These conditions are closely linked and can worsen each other. Together, they are sometimes called cardio-metabolic-renal disease. Treating these conditions early and effectively is important to help people live longer and healthier lives. This article reviews recent evidence about a group of medicines, called sodium&#x2013;glucose cotransporter 2 inhibitors, often shortened to SGLT2 inhibitors, that were first developed to lower blood sugar in people with type 2 diabetes mellitus. Over the last decade, large clinical studies have shown that they also protect the heart and kidneys, even in some people who do not have diabetes. The authors reviewed published medical studies on four SGLT2 inhibitors currently approved in Europe. They looked at how these medicines work, how effective they are, how safe they are, and whether they are good value for healthcare systems. The aim was to help doctors understand when and how to use these medicines in people with type 2 diabetes mellitus, heart failure or chronic kidney disease. All SGLT2 inhibitors lower blood sugar by helping the kidneys remove excess glucose through the urine. Beyond this effect, they also reduce body weight and blood pressure. More importantly, they lower the risk of being admitted to hospital for heart failure and slow the worsening of kidney disease.Large studies showed that some agents of this group are effective treatments for heart failure and chronic kidney disease, even in people without diabetes. These medicines reduced the risk of kidney failure, hospital stays and early death. Benefits were seen across many patient groups, including older adults and people taking multiple medications. Side effects were generally mild and manageable. The most common problems were genital infections and dehydration, which usually improved with simple treatment or dose adjustments. Serious side effects were rare. Overall, the benefits of treatment were much greater than the risks for most patients. Heart disease and kidney disease are major causes of illness, hospitalization and healthcare costs. This review shows that SGLT2 inhibitors do more than control blood sugar &#x2014; they help protect vital organs, improve quality of life and may help people live longer.Using these medicines earlier in the course of disease may prevent serious complications before they occur. Studies also suggest that SGLT2 inhibitors can reduce long-term healthcare costs by delaying the need for dialysis, hospital care and other expensive treatments.In summary, SGLT2 inhibitors represent an important advance in the treatment of diabetes, heart failure and chronic kidney disease. They offer a simple, once-daily treatment that benefits the heart and kidneys, as well as blood sugar levels, making them a valuable option for many patients and an important tool for modern healthcare.

Emery-Dreifuss muscular dystrophy (EDMD) is a rare inherited neuromuscular disorder within the spectrum of nuclear envelope diseases, classically characterized by early musculo-tendinous contractures, slowly progressive myopathy, and cardiac involvement dominated by conduction disease and arrhythmias, with variable evolution toward cardiomyopathy and heart failure. This narrative review provides a comprehensive and clinically actionable synthesis of cardiovascular manifestations across EDMD genotypes and phenotypes, outlining pragmatic diagnostic and therapeutic pathways for real-world care. A targeted literature search was performed in PubMed, Embase, and Web of Science, focusing on studies addressing cardiovascular involvement in EDMD. Relevant original studies, case series, registries, guideline documents, and high-quality reviews were selected and synthesized narratively, with particular emphasis on diagnostic strategies, risk stratification, and management approaches. Cardiac involvement in EDMD encompasses a broad and heterogeneous spectrum, including atrial disease and conduction disturbances, ventricular arrhythmias, dilated cardiomyopathy, thromboembolic complications, and sudden cardiac death. Phenotypic expression varies according to the underlying genetic substrate, with distinct atrial- and ventricular-dominant trajectories. Early recognition and structured cardiovascular surveillance are essential to guide timely intervention, including anticoagulation, device therapy, and heart failure management. Despite growing awareness, significant gaps remain in risk prediction and standardized management strategies. EDMD represents a paradigmatic model of cardiomyopathy characterized by prominent electrical instability and systemic involvement. A structured, genotype- and phenotype-informed approach centered on early surveillance, proactive arrhythmia and thromboembolic risk management and timely device therapy may improve clinical decision-making in real-world settings. Future perspectives include the integration of precision medicine and the development of gene- and pathway-targeted therapies, with the potential to shift from symptomatic management toward disease-modifying strategies.

This review maps the existing evidence regarding the Social Determinants of Health (SDH) on women with heart failure (HF) in Europe, focusing on healthcare access, diagnostic pathways, clinical management and outcomes. This review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. A systematic search of six electronic databases in September 2025 yielded 3728 articles. Articles were eligible for inclusion if they featured women (aged &#x2265;18 years) with a diagnosis of HF, were conducted in countries within the WHO-defined European Region, and specifically examined the impacts of SDH on this population. Following a two-stage screening process, 30 papers met the inclusion criteria. Data synthesis and reporting were guided by the PAGER framework (Patterns, Advances, Gaps, Evidence, and Recommendations). Nine dominant patterns were identified, centred largely on socioeconomic status, gender disparities in clinical care, and the impact of gendered labour expectations on health-seeking behaviour. These determinants significantly delay HF diagnosis and affect treatment optimisation among European women. However, a critical gap remains in sex- and age-disaggregated data with European HF datasets and research. Evidence for practice highlights the need for equity-focused care that incorporates social context into clinical management, while research recommendations prioritise investigating the underlying mechanisms behind the SDH-HF relationship to develop targeted interventions. Social determinants are fundamental drivers of heart failure outcomes for women in Europe. Addressing the intersection of structural socioeconomic barriers and clinical management is essential to mitigating health disparities and achieving care equity and outcomes for women living with HF.

Acute decompensated heart failure (ADHF) is associated with inflammation. Inflammatory biomarkers in patients with ADHF are associated with increased mortality. Glucocorticoids mitigate systemic inflammation and may therefore have a therapeutic role in ADHF. We aim to investigate the effects of adding glucocorticoids to standard of care in the treatment of ADHF. This protocol for a systematic review with meta-analysis is conducted according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will conduct a systematic review of randomized clinical trials comparing glucocorticoids with placebo or any other control in patients hospitalized with ADHF. The primary outcome is all-cause mortality. Secondary outcomes include length of hospitalization, all-cause hospitalizations and rehospitalization for heart failure. A comprehensive search will be conducted across Medline, Embase, the Cochrane Central Register of Controlled Trials, the Latin American and Caribbean Literature on Health Sciences, and Web of Science, and Covidence will be used to independently screen all results by two authors. The search is planned to begin in April 2026. A meta-analysis and Trial Sequential Analysis will be conducted on eligible trials. Risk of bias will be evaluated using the Cochrane Risk of Bias tool-version 2. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). This systematic review and meta-analysis will synthesize the available randomized evidence on glucocorticoids as an adjunct to standard care in patients hospitalized with ADHF, with the aim of assessing their therapeutic potential in this population and identifying gaps to inform future research.

Interest in clinical research on the role of acupuncture in heart failure (HF) is growing. The purpose of this review was to visually map, compile, and summarize the existing literature to guide future research on acupuncture for HF. Acupuncture-related publications for HF were sourced from four databases: Cochrane Library, PubMed, ScienceDirect, and Scopus. We used VOSviewer, Bibliometrix, and Biblioshiny to create a map-based data network of all studies related to keywords, illustrating the interconnections among journals, sources, authors, and funders. We conducted a scoping review (ScR), adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards. We included articles exploring acupuncture intervention on HF, published from January 1, 1992, to July 15, 2024. Articles were declared eligible, reviewed critically, and synthesized narratively. We have identified the most dynamically active institutions, authors, funders, and research outcomes. Eight articles were included in the synthesis of ScR. Research in this area is increasing sharply, with the maximum number of publications occurring during the interval between 2021 and 2023. The trend of research development in the field of acupuncture for HF appears to be growing with various variations of acupuncture modalities that can be opportunities for further research, especially regarding the effectiveness of each modality. The benefits and potential of acupuncture materials for HF promise an excellent opportunity to advance research and treatment development. Acupuncture has promising potential for the future treatment of HF.

Congestion drives symptoms and adverse outcomes in heart failure (HF), and loop diuretics remain the cornerstone of decongestion. Yet randomized trials of diuretic strategies and other acute decongestive approaches have not shown mortality benefit, while mechanistic studies demonstrate rapid neurohormonal activation after acute loop diuretic administration. In chronic HF, observational data consistently associate higher loop diuretic requirements-particularly above &#x223c;40&#x2005;mg/day furosemide equivalent or with dose escalation-with worse prognosis across HF phenotypes, though confounding by disease severity is likely. Decongestion needs vary across the HF trajectory: early guideline-directed therapy provides intrinsic decongestive effects, whereas advanced HF is marked by diuretic resistance and renal vulnerability. Preload-dependent states (notably cardiac amyloidosis and selected HFpEF phenotypes) require especially careful titration to avoid hypovolemia and low output, and robust protocol-level trial evidence is lacking. Contemporary randomized data do not demonstrate superiority of torsemide over furosemide. Small trials and systematic reviews suggest that in carefully selected, stable, non-congested patients, diuretic withdrawal or reduction can be feasible, with &#x223c;25-35% requiring re-initiation within 1-3 months and consistent lowering of renin activity; however, clinical outcome benefit remains unproven. Overall, evidence supports maintaining euvolemia with the lowest effective diuretic dose and considering monitored deprescribing in appropriate low-risk patients.

High-sensitivity C-reactive protein (hsCRP) is gaining recognition as an important prognostic biomarker in cardiovascular diseases (CVDs), including atherosclerotic CVD (ASCVD), with and without chronic kidney disease (CKD), and heart failure (HF). Evidence suggests that systemic inflammation, measured by hsCRP, is prevalent in individuals with ASCVD, CKD, and HF, and is linked to increased risk of cardiovascular events. This review explores the interconnectedness of ASCVD, CKD, and HF within the cardiovascular-kidney-metabolic axis, with systemic inflammation emerging as a common underlying driver. Prevalence estimates show that systemic inflammation (hsCRP &#x2265; 2 mg/L) is found in 38% to 59% of patients with ASCVD, in 42% to 65% of those with both ASCVD and CKD, and in over 50% in various HF cohorts. Elevated levels of hsCRP are consistently associated with higher rates of major adverse cardiovascular events and mortality across these populations. Although hsCRP is frequently found to carry prognostic value independent of traditional biomarkers such as low-density lipoprotein cholesterol, its clinical adoption in practice is held back in part by guideline variability, lack of standardized cutoffs, and debate over how results may change clinical management with currently available therapies. The review calls for further research to define optimal hsCRP thresholds, examines the role of hsCRP in cardiovascular risk assessment, and reviews the ongoing development programs for emerging anti-inflammatory therapies. Addressing systemic inflammation could become a cornerstone of CVD management, potentially reducing residual risk beyond traditional targets.

Heart failure with preserved ejection fraction (HFpEF) is highly prevalent and associated with substantial morbidity and mortality. The clinical benefit of mineralocorticoid receptor antagonist (MRA) therapy in this population remains uncertain. A meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, searching PubMed, Embase, and Scopus from inception through the most recent available data to identify randomized controlled trials and observational cohort studies comparing MRAs with placebo or no MRA therapy in adults with HFpEF. Primary outcomes were all-cause mortality, cardiovascular mortality and HF hospitalization, while secondary outcomes included hyperkalemia. Random-effects models were used to pool risk ratios (RRs) or hazard ratios with 95% confidence intervals (CLs). Twenty-one reports representing 11 unique studies comprising 50,983 patients met the inclusion criteria; 8,976 received MRA therapy, and 28,999 served as controls. MRA use was not associated with a statistically significant reduction in all-cause mortality (RR 0.91, 95% CI 0.81 to 1.02) or cardiovascular mortality (RR 0.84, 95% CI 0.66-1.05; p = 0.13). MRA therapy, however, was associated with a significant reduction in HF hospitalization (RR 0.81, 95% CI 0.73 to 0.90; p <0.0001). MRA use was also associated with an increased risk of hyperkalemia (RR 2.04, 95% CI 1.55 to 2.68; p <0.00001). In conclusion, MRA therapy in HFpEF reduces HF hospitalization without a significant mortality benefit and is associated with increased hyperkalemia risk.