搜索结果：International journal of heart failure

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.

Respiratory infections are major triggers of heart failure (HF) decompensation, and current guidelines recommend vaccination-particularly influenza and pneumococcal vaccination-for patients with HF. We conducted a survey to assess Korean healthcare professionals' (HCPs) awareness, perception, and clinical practices regarding vaccination in HF, including attitudes to newer vaccines and perceived barriers to implementation. A web-based survey was conducted from July to August 2025 among members of the Korean Society of Heart Failure, yielding 171 responses from 2,515 invitees. The 22-item questionnaire covered four domains related to vaccination in HF. Awareness of the importance of vaccination in HF was very high, with over 95% of respondents rating it as "important" or "very important," and 86.6% reporting prior experience in prescribing or recommending vaccines. Influenza and pneumococcal vaccines were the most consistently recommended as indicated for HF and were also the most frequently implemented in practice. Vaccination was primarily viewed as a strategy to reduce infection-related HF exacerbations, and HF specialists were most often considered the appropriate providers to recommend vaccination. In contrast, awareness and real-world recommendation of newer vaccines, including herpes zoster, coronavirus disease 2019, and respiratory syncytial virus, were substantially lower. Commonly reported barriers included limited time during outpatient visits, patients' lack of awareness of vaccination necessity, financial burden, and concerns about adverse reactions. While Korean HCPs demonstrate high awareness of the importance of vaccination in HF, significant discordance remains between self-reported knowledge and clinical implementation, particularly for newer vaccines. Addressing constraints and enhancing education for both providers and patients are essential to improve vaccination rates in this high-risk population.

The T&#xfc;rkiye Heart Failure (TURK-HF) registry aims to identify the sociodemographic and clinical characteristics, management strategies, and outcomes of patients with heart failure (HF) and to assess the implementation of evidence-based HF therapies in T&#xfc;rkiye. The TURK-HF registry is a national, multicenter, prospective, observational study of unselected patients with HF regardless of ejection fraction. A total of 46 investigators from 38 centers in 22 cities across T&#xfc;rkiye participated in the registry. The study investigators will gain access to the electronic case report form via www.turkhf.com website using their usernames and passwords. The baseline assessment of the patients will include sociodemographic data, primary care access information, frailty assessment, health-related quality of life questionnaire, HF-related information, medical history and comorbidities, physical examination findings, electrocardiographic and echocardiographic data, H2FPEF score calculation, laboratory results, and medical and device-based HF therapies. The management strategies and potential complications of patients hospitalized with acute HF will be systematically documented. Follow-up data will be collected at regular outpatient visits every 6 months with a margin of error of 1 month. The clinical endpoints of the TURK-HF registry were cardiovascular or all-cause mortality, HF-related hospitalizations, clinician-interpreted outcomes, patient-reported outcomes, and surrogate endpoints, either alone or in combination. The TURK-HF registry was registered at ClinicalTrials.gov (ID: NCT06707220). The TURK-HF registry offers comprehensive and distinctive insights into contemporary HF clinical characteristics, diagnostic methods, treatments, and outcomes. This registry has the potential to influence implementation strategies, clinical research, and public policies across T&#xfc;rkiye.

Heart failure (HF) remote monitoring programs collect HF-related parameters from cardiac implantable electronic devices, enabling early interventions and reducing healthcare burdens. This study aimed to characterize HF patients, alert burden, and the association between TriageHF&#xae; alerts and HF decompensation. This retrospective observational study, 134 patients enrolled in an outpatient remote monitoring HF program with the TriageHF&#xae; algorithm between February 2022 and July 2023. Data on alert frequency, data driving the alerts, and alert duration were collected. Clinical outcomes included unplanned emergency room visits, HF hospitalizations, all-cause death, and a composite of these events. Over a median follow-up of 1.7 years, 77 individual high-risk alerts (0.44 alerts per patient-year) occurred. HF patients who eventually had an alert were similar to those without any alerts, except for the increased prevalence of chronic kidney disease, stroke history and use of furosemide. The event rate was 1.1% per month, and the alert state was 3.2% of the total follow-up duration. Six events occurred during high-risk days (event rate of 7.9% per month vs. 0.8% per month during standard-risk days). TriageHF&#xae; alerts demonstrated a sensitivity of 35%, a specificity of 71%, a positive predictive value of 25%, and a negative predictive value of 80% for predicting a composite of HF hospitalization, unplanned ER visits, and death. The TriageHF&#xae; algorithm identified periods with a higher incidence of HF-related adverse events, supporting efficient resource allocation. The low alert burden also supports feasibility in resource-limited settings.

Opioid misuse has become a widespread public health issue, affecting diverse patient populations, including those with heart failure. Given that heart failure with preserved ejection fraction (HFpEF) constitutes nearly half of all heart failure cases, understanding its management and the influence of various factors on patient outcomes is essential. This study seeks to evaluate the outcomes of chronic opioid therapy in patients with HFpEF. Utilizing the National Inpatient Sample (2016-2020), adult HFpEF patients were identified using the appropriate International Classification of Diseases, Tenth Revision codes, excluding those with end-stage renal disease. Outcomes were compared between chronic opioid users and nonusers. Multivariate logistic and linear regression analyses were conducted, controlling for various patient and hospital confounders. The primary outcome measured was all-cause in-hospital mortality, with secondary outcomes including acute kidney injury/hemodialysis (AKI/HD), cardiogenic shock, cardiac arrest, mechanical ventilation, length of stay, and total hospital charges. Among 1,557,344 HFpEF patients, 21,655 (1.4 percent) were on chronic opioid therapy. No significant difference in inpatient mortality was found (adjusted odds ratio [aOR] 1.04, 95 percent confidence interval [CI]: 0.88-1.24, p = 0.58). A nonsignificant increase in cardiogenic shock (aOR 1.12, 95 percent CI: 0.85-1.48, p = 0.39) and cardiac arrest (aOR 1.06, 95 percent CI: 0.81-1.38, p = 0.65) was noted in chronic opioid users. However, chronic opioid use was associated with a higher risk of AKI/HD (aOR 1.15, 95 percent CI: 1.07-1.24, p < 0.001) and mechanical ventilation (aOR 1.27, 95 percent CI: 1.14-1.41, p < 0.001). Opioid use was also linked to longer hospital stays (adjusted mean difference [aMD] 1.15 days, 95 percent CI: 0.83-1.47, p < 0.001) and a nonsignificant increase in total charges (aMD USD 3,615, 95 percent CI: USD -1.014 to USD 8,245, p = 0.12). While chronic opioid use in hospitalized HFpEF patients did not significantly affect in-hospital mortality, it was associated with a higher risk of other adverse events and longer hospital stays.

to describe the garbage codes (GCs) identified in the Global Burden of Disease Study (GBD) 2023 and their redistribution to underlying causes of death in Italy in 2021. Specifically, the study aims to: 1. compare temporal trends in the proportion of GCs in Italy with those of other Western European countries with similar population sizes; 2. identify the most frequent GC packages, analyze their geographic distribution, and determine the causes to which they are reassigned; 3. examine the relationship between the proportion of GCs and contextual factors related to death certification, including the type of certifier, place of death, and requests for autopsy. descriptive epidemiological study based on GBD 2023 estimates. the analysis focuses on the Italian population in 2021, stratified by 21 subnational units, including 19 regions and 2 autonomous provinces. total number of deaths; number of GCs, defined as deaths attributed to causes that do not represent underlying causes of death; percentage of GCs, calculated as the number of GCs divided by total deaths and multiplied by 100. the proportion of GCs in Italy gradually decreased over time, from 34.6% in 1990 to 28.8% in 2021. In 2021, the three most frequent GC packages at the national level were 'unspecified type of stroke' (4.28% of total deaths), 'unspecified type of diabetes' (2.44%), and 'heart failure, right or left' (2.38%). In the same year, the proportion of GCs was positively correlated with the share of deaths occurring at home (r 0.71; p <0.001), with missing data on the type of certifying physician (r 0.54, p=0.020), on place of death (r 0.77, p <0.001), and on autopsy requests (r 0.76, p <0.001). misreporting of causes of death arises from multiple mechanisms, reflecting errors of different nature and severity, with important implications for public health policies and health information systems. While redistribution methods are essential to produce comparable and policy-relevant estimates, improving data quality at the source remains a critical priority.

Acute decompensated heart failure (HF) is a leading cause of hospital admissions, often associated with poor outcomes. The Triage-HF (Medtronic&#xae;) and HeartLogic (Boston Scientific&#xae;) algorithms, when integrated into implantable devices, have demonstrated the ability to predict these events with high accuracy. REMOTI-HF aims to evaluate whether responding to algorithm-generated alerts through structured remote clinical assessment can reduce HF-related events and improve outcomes. The REMOTI-HF Clinical Trial is a single-centre, randomized controlled trial designed to evaluate the effectiveness of clinical evaluation and therapeutic optimization guided by the Triage-HF and HeartLogic algorithms to reduce HF-related events in patients with advanced HF. Approximately 500 patients are expected to be enrolled. Inclusion criteria include having an implantable device compatible with these algorithms and a left ventricular ejection fraction &#x2264;35% at the time of device implantation. Patients will be excluded if they are listed for heart transplant, have ventricular mechanical support, are younger than 18 or older than 85 years, have severe cognitive impairment, are pregnant or have a life expectancy of less than one year. The primary endpoint is a composite of major HF events-including all-cause mortality, hospital admissions for HF, urgent HF hospital visits, ventricular arrhythmias and atrial arrhythmias requiring medical evaluation. The trial is registered at ClinicalTrials.gov (NCT06422832). REMOTI-HF will provide insights into the effectiveness of clinical assessment guided by HeartLogic and Triage-HF algorithm alerts in reducing HF-related events. These findings may pave the way for more sophisticated remote monitoring strategies that build on existing device algorithms. ClinicalTrials.gov Identifier: NCT06422832.

The prognostic significance of ischemic evaluation in patients with new-onset heart failure is not well understood and may differ according to age and sex. In a real-world cohort, we analyzed the long-term mortality risk after undergoing an ischemic evaluation. All new-diagnosed heart failure patients 2008-2018 without prior ischemic evaluation, known coronary artery disease, or acute myocardial infarction were identified from the Danish National patient registry. The association of an ischemic evaluation within 90 days of heart failure diagnosis with long-term mortality was analyzed by inverse probability weighted Cox regression models. A total of 61,475 patients were included (mean age 73.3&#xb1;13.9 years, 46% women), of which 12,503 (20%) underwent an ischemic evaluation. During a mean follow-up of 4.6 years, 37% of patients died, corresponding to a mortality rate of 8.0 (7.9-8.1) per 100 person-years. The multivariable-adjusted hazard ratio of death was 0.92 (95% confidence interval, 0.90-0.95) for patients who underwent ischemic evaluation, compared with patients who did not. An ischemic evaluation was associated with a lower hazard ratio in males than females: 0.87 (0.84-0.90) vs. 0.98 (0.94-1.02), and in middle-aged vs. older or younger individuals: 0.91 (0.75-1.12) in patients &#x2264;50 years, 0.82 (0.72-0.93) in 51-60 years, 0.83 (0.79-0.87) in 61-75 years, 0.93 (0.88-0.97) in >75-85 years, and 1.02 (0.97-1.07) in >85 years, respectively. Obtaining an ischemic evaluation was associated with marginal to no improvement in long-term mortality for many new-diagnosed heart failure patients, including the very elderly.

Despite advances in therapy, data on long-term survival and temporal mortality patterns in real-world heart failure (HF) populations, particularly during the critical early period after diagnosis or clinical destabilization, remain scarce. This study aimed to analyze long-term survival and identify factors associated with mortality in a prospective Russian real-world HF cohort that is relatively underrepresented in the international registry literature. A prospective 5-years registry study consecutively enrolled 150 patients with HF in February-May 2018. Participants underwent comprehensive assessment of clinical state, traditional cardiovascular risk factors (RF), psychosocial RF, quality of life, perception of illness, cognitive function, and treatment characteristics. Survival was analyzed using the Kaplan-Meier method, and mortality trends were assessed over time. The Cox proportional hazard model, with calculation of hazard ratio (HR) and 95% coincidence interval (CI), was used for univariate and multivariate regression analyses. The cohort (median age 69&#xa0;years, 57% male) was elderly and multimorbid, with high prevalence of coronary artery disease (95%), hypertension (91%), and chronic kidney disease (56%). Guideline-directed medical therapy was suboptimal: while beta-blocker and diuretic use was high (87% and 79%, respectively), utilization of aldosterone antagonists and ARNI was low (40% and 0.7%, respectively). Only 32.7% received multicomponent HF therapy. The overall 5-years (0.02-5.09) survival rate was 59.9%. Approximately half (48%) of patients died in the first year, the remaining deaths occurred in 2-nd, 3-rd and 4-th years (15%, 17%, and 20%, respectively), and deaths were recorded during 5-th and 6-th years of follow-up. Kaplan-Meier survival analysis showed that left ventricular ejection fraction (LV EF) was strongly associated with 5-years survival. In patients with reduced and moderately reduced LV EF 5-years survival was significantly lower than that in those with preserved LV EF (50.0% and 45.7% versus 70.4%, respectively). No significant difference was found only when comparing the survival curves of patients with moderately reduced and reduced LV EF (chi-square&#xa0;=&#xa0;0.014; p&#xa0;=&#xa0;0.906). The leading cause of death was decompensation of HF (65.2%), followed by sudden cardiac death (15.2%). Multivariate analysis showed that age (HR 1.03 per 1-year increase; 95% CI 1.01-1.06; p&#xa0;=&#xa0;0.017), weight loss >4.5&#xa0;kg in 5&#xa0;days in response to therapy (HR 3.49; 95% CI 1.82-6.68; p&#xa0;<&#xa0;0.001), anemia (HR 2.83; 95% CI 1.47-5.46; p&#xa0;=&#xa0;0.002), obstructive sleep apnea syndrome (HR 4.43; 95% CI 1.91-10.28; p&#xa0;=&#xa0;0.001), and HF NYHA functional class IV (HR 4.79; 95% CI 1.50-15.34; p&#xa0;=&#xa0;0.008) were independent predictors of 5-years all-cause mortality in HF patients. This study identifies a high early mortality phenotype in a real-world HF population, strongly associated with significant gaps in guideline-directed therapy. The findings underscore the urgent need for early aggressive optimization of treatment, particularly in the high-risk period following diagnosis or destabilization of HF, to improve long-term survival.

Heart failure (HF) is a leading cause of mortality and morbidity in South Korea and imposes substantial physical, emotional, and economic burdens on patients, families, and society. Despite the high symptom burden and complex care needs of patients with HF, palliative care and hospice services remain underutilized owing to cultural, institutional, and knowledge-related barriers. This guideline from the Korean Society of Heart Failure (KSHF) provides evidence-based recommendations to integrate palliative and hospice care across the HF disease trajectory, with the aim of improving quality of life, alleviating suffering, and supporting holistic care for patients and their caregivers. By clarifying the role and scope of palliative care in HF, and suggesting models for collaborative care between cardiology and palliative teams, these recommendations seek to bridge the gap between HF and palliative care services in South Korea and to promote goal-concordant, patient-centered decision-making.

Glucagon-like peptide-1 (GLP-1)-based therapies have emerged as a major advance in cardiometabolic care; however, no prospective outcomes data exist for these agents in non-diabetic adults with rheumatoid arthritis (RA) and obesity. We examined whether GLP-1-based therapy was associated with first post-landmark ICD-10-documented heart failure (HF) or respiratory failure (RF) events. We conducted a retrospective cohort study in the TriNetX US Collaborative Network. Adults with RA, body mass index&#x2009;&#x2265;&#x2009;30&#xa0;kg/m2, and baseline-year disease-modifying antirheumatic drug (DMARD) therapy were included; patients with diabetes and overlapping systemic autoimmune diseases were excluded. Exposure was semaglutide or tirzepatide documented within 0-90&#xa0;days after the index BMI, and comparators were strict never-users. Cohorts were propensity score-matched 1:1 on 68 covariates. The primary endpoint was the first post-landmark ICD-10-documented HF or RF during days 91-365 among patients without pre-index documentation of the corresponding endpoint. After matching, 3483 patients remained per cohort, with all standardized mean differences&#x2009;<&#x2009;0.10. During days 91-365, the primary endpoint occurred in 23/3176 GLP-1 users (0.7%) and 57/3144 never-users (1.8%) (hazard ratio (HR): 0.48; 95% confidence interval (CI): 0.30-0.78; p&#x2009;=&#x2009;0.002; absolute risk difference:&#x2009;-&#x2009;1.1 percentage points). The HF and RF components showed directionally similar associations. Findings were directionally similar at extended follow-up and, where estimable, in the calendar-time-restricted analysis. Bias probes showed no differential utilization. GLP-1-based therapy was associated with substantially lower hazards of first post-landmark ICD-10-documented HF or RF events. These observations, while compelling, are hypothesis-generating and require prospective validation before informing clinical use. Key Points &#x2022; In a propensity score-matched TriNetX cohort of non-diabetic adults with rheumatoid arthritis and obesity, GLP-1-based therapy was associated with a lower hazard of first post-landmark ICD-10-documented heart failure or respiratory failure events. &#x2022; In absolute terms, the primary composite occurred in 0.7% of GLP-1 users and 1.8% of never-users during days 91-365, corresponding to approximately one fewer event per 100 patients. &#x2022; Heart failure and respiratory failure, analyzed separately, showed directionally consistent lower hazards, although event counts were small. &#x2022; The findings provide preliminary RA-specific evidence for a prospective study, but they should not be used to guide treatment decisions.

Heart failure (HF) remains a major cause of morbidity and frequent readmissions in India. Ambulatory blood pressure monitoring (ABPM) offers dynamic evaluation of blood pressure (BP) patterns, BP variability and morning blood pressure surge (MBPS) which may provide prognostic value in patients with acute decompensated heart failure (ADHF). A prospective observational study enrolling 300 patients admitted with ADHF. After stabilization and prior to discharge, all patients underwent ABPM and were categorized based on dipper patterns. Clinical outcomes, including mortality and re-hospitalization at 3 months, were assessed. Survival analyses were performed using Kaplan-Meier curves and multivariable Cox regression. The mean age of the cohort was 60.2 years; 68% were male. Most patients had HF with reduced ejection fraction (84%), and 57% were hypertensive. Dipper patterns were distributed: normal dipper 51%, non-dipper 36%, reverse dipper 11%, and extreme dipper 2%. At 3 months, mortality was 5.3% and re-hospitalization in 44% of patients. Kaplan-Meier analysis revealed increased mortality in reverse dippers, highest average real variability percentile, and low/high MBPS groups (p<0.0001). Multivariable Cox regression identified extreme dipper (hazard ratio [HR], 9.28; 95% confidence interval [CI], 1.85-46.49; p=0.007), reverse dipper (HR, 7.53; 95% CI, 2.47-22.10; p=0.01), low systolic BP (HR, 3.70; 95% CI, 1.22-11.22; p=0.02) associated to mortality. ABPM is a practical tool for risk stratification in HF. Abnormal nocturnal BP dipper patterns and increased BP variability were associated with increased adverse short-term outcomes in ADHF. Discharge ABPM may aid early risk stratification, while other circadian BP abnormalities primarily reflect disease severity rather than independent risk.

The six-minute walk test (6MWT) is widely used to assess functional capacity in chronic heart failure (CHF) but is limited by space and logistics. The two-minute step test (2MST) is a practical alternative. This study aimed to determine an optimal 2MST cut-off for reduced functional capacity and compare its responses with the 6MWT. In this cross-sectional study, 60 clinically stable patients with CHF (mean age 51.45&#xb1;12.65 years; 77% male) completed the 2MST, 6MWT, and quadriceps maximal voluntary contraction assessments. Physiological and perceptual responses were recorded at baseline, immediately after, and five minutes post-test. Receiver operating characteristic analysis determined the optimal 2MST cut-off. Adjusted regression examined functional associations, and responses were compared between tests. A 2MST cut-off of &#x2265;94 steps showed good discrimination for reduced functional capacity (area under the curve, 0.82; 95% confidence interval, 0.71-0.92; sensitivity, 82.9%; specificity, 64.0%). In adjusted analyses, the cut-off remained independently associated with greater six-minute walk distance and lower post-exercise leg fatigue (p=0.001), but not with quadriceps strength. Compared with the 6MWT, the 2MST induced greater post-exercise leg fatigue (p<0.001), while other cardiorespiratory and perceptual responses were similar (p>0.05). The 2MST is a safe and feasible submaximal test for assessing functional capacity in CHF. A 94-step cut-off may help identify patients with reduced functional capacity, particularly when corridor-based testing is not feasible.

Right ventricular dysfunction (RVD) is associated with poor prognosis in patients with acute heart failure (HF), including cardiogenic shock (CS). We evaluated the association of RVD by transthoracic echocardiogram (TTE) with mortality in cardiac intensive care unit (CICU) patients with HF. We conducted a retrospective cohort of patients with HF admitted to the Mayo Clinic CICU (2007-2018) who had a TTE within one day of admission. TTE-derived global assessment of right ventricular (RV) function was graded on a semi-quantitative scale. Outcomes included in-hospital and one-year mortality. Among 2,450 patients (median 71.6 years, 38.4% female, 91.2% White), 75.7% had RVD (36.9% moderate/severe RVD). Global assessment of RVD correlated with advanced Doppler hemodynamics. Short-term mortality increased according to RVD severity (adjusted odds ratio, 1.30 per degree of RVD; 95% confidence interval [CI], 1.15-1.47, p<0.001), with similar findings after stratification by left ventricular function and CS (25.2% of the cohort). One-year mortality increased with RVD severity (adjusted hazard ratio, 1.21 per degree of RVD; 95% CI, 1.14-1.28, p<0.001). Severe RVD was associated with 51.2% one-year mortality (median survival 9.9 months). Patients with moderate/severe RVD without CS had similar mortality to those with mild/no RVD with CS. RVD is common among CICU patients with acute HF, and TTE-derived global assessment of RV function correlates with advanced Doppler hemodynamics. RVD severity by global assessment is associated with higher short- and long-term mortality, highlighting the potential utility of point-of-care ultrasound for risk stratification in CICU patients.

The intersection of obesity and heart failure (HF) represents a growing epidemic characterized by a distinct cardiometabolic phenotype. Historically, management has been hamstrung by a significant therapeutic gap: lifestyle interventions often fail to overcome metabolic inertia, yielding negligible weight reduction, while bariatric surgery remains limited by invasiveness. The emergence of Nutrient-Stimulated Hormone (NuSH) therapies, including glucagon-like peptide-1 receptor agonists, has revolutionized this landscape. This review delineates the paradigm shift driven by these agents, which act as a "medical bypass" offering surgical-magnitude weight loss and broad pleiotropic cardioprotection. We analyze pivotal evidence from the STEP-HFpEF and SUMMIT trials, demonstrating that NuSH therapies have established a new standard of care in heart failure with preserved ejection fraction (HFpEF) by not only restoring functional capacity but also significantly reducing hard clinical endpoints. Conversely, we navigate the uncertainty surrounding heart failure with reduced ejection fraction (HFrEF), where historical safety signals regarding chronotropic effects and arrhythmias necessitate a cautious, precision-based approach. Finally, we discuss critical future frontiers, emphasizing the "muscle imperative" to mitigate sarcopenic obesity and the need for biomarker-guided protocols. NuSH therapies have evolved from metabolic tools into essential disease-modifying pillars, necessitating a fundamental recalibration of clinical practice to target the metabolic root of HF.

When patients are hospitalised for heart failure (HF), doctors review and optimise their pharmacotherapy at subsequent care transitions. Studies show that patients, many of whom are old and frail, have adherence rates of only 40%-60%. Few communication studies have examined the burden of optimisation on patients as their regimens evolve. Focusing on prescription changes over multiple care transitions, we aimed to: (1) identify how many changes patients received, (2) characterise the support provided in discharge letters, and (3) assess patients' implementation of changes at home. We conducted an exploratory, observational cohort study with prospective longitudinal data collection. We recruited 23 older HF patients in Norway, collecting observational data (medical records, discharge letters, interviews, photographs) from their hospital visits (admission, discharge), general practitioner visit, and their homes. We inductively developed a systematic analytical procedure to identify prescription changes and to assess the quality of doctors' written information about patients' medication management at home. Doctors made a median of six prescription changes per patient (range 2-19) over a median timespan of 25 days, usually leading to more medications. Of the discharge letters patients received, 26% provided clear instructions about all changes and explanations of the benefit. While all patients reported adherence, home visits revealed 17% had discrepancies indicating non-adherence, and 61% dispensed medications from original pharmacy packaging with outdated dosing instructions. To adhere to their optimised pharmacotherapy, HF patients needed to implement many incremental changes. Doctors' discharge letters were often unclear or lacked information about the changes. To enhance patients' ability to adhere to treatment, clinicians may consider: (i) improving the quality of discharge letters, including clarifying medication labels (ii) providing updated instructions for old medication packages, (iii) normalising and providing safety-net support for non-adherence to HF regimens. Further research is needed to test these actions.

Right heart catheterization (RHC) remains the gold standard for the invasive assessment of cardiovascular hemodynamics, enabling direct measurement of right atrial, right ventricular, pulmonary artery, and pulmonary arterial wedge pressures, as well as cardiac output and mixed venous oxygen saturation. Although earlier randomized trials questioned the routine use of pulmonary artery catheters in critically ill patients, RHC continues to play a crucial role in the diagnosis and management of pulmonary hypertension, advanced heart failure, cardiogenic shock, and complex structural or valvular heart disease. The clinical value of RHC, however, depends not only on performing the procedure but also on obtaining accurate and physiologically meaningful measurements. This review summarizes contemporary best practices for performing RHC in routine clinical practice. Key procedural considerations include defining the clinical objective prior to catheterization, selecting appropriate vascular access, ensuring correct transducer leveling and signal fidelity, and accounting for respiratory variation and hemodynamic conditions during pressure acquisition. The review also discusses methodological aspects of measuring pulmonary arterial wedge pressure, cardiac output, and intracardiac shunts, and highlights common technical pitfalls that may lead to misinterpretation of hemodynamic data. In addition, the evolving role of RHC in clinical decision-making is reviewed, including its application in the hemodynamic classification of pulmonary hypertension, vasoreactivity testing, exercise hemodynamics for suspected heart failure with preserved ejection fraction, and differentiation of constrictive pericarditis from restrictive cardiomyopathy. Standardized acquisition and careful interpretation of hemodynamic data are essential to maximize the diagnostic and therapeutic value of RHC in contemporary cardiovascular practice.

Frailty is prevalent in older adults and affects up to half of people living with heart failure, contributing to functional decline, hospitalisation, poor quality of life, and mortality. Malnutrition manifests in frail older adults with heart failure, making nutrition a central determinant of altering the frailty trajectory. Nutritional care is commonly considered an ancillary service rather than a therapeutic component of care in multimorbid conditions. This perspective, informed by evidence, argues for repositioning "food is medicine" as a shared, preference-sensitive therapeutic strategy for frailty prevention and reduction in people with heart failure. "Food is medicine" is an intentional approach shifting beyond nutrient supplementation, positioning diet as a first-line, patient-centred intervention that supports dignity, muscle preservation, symptoms management, and functional resilience. Coordinated action across clinical practice, policy, and research is necessary to ensure nutrition is recognised and delivered as core therapy for frail individuals with heart failure.

Hypertrophic cardiomyopathy (HCM) is associated with an elevated risk of sudden cardiac death, often preceded by an out-of-hospital cardiac arrest (OHCA). However, population-based estimates of OHCA risk in patients with HCM are limited. To estimate the risk of OHCA in patients with HCM and identify characteristics associated with OHCA. This cohort study used multiple Danish registers during an observation period ranging from June 1, 2001, to December 31, 2022, and included a nested case-control study. All Danish residents aged 18 to 85 years during the study period constituted the source population. Patients with HCM were identified using codes from the International Statistical Classification of Diseases, Tenth Revision. The cohort included patients with a first-time HCM diagnosis and exposure-matched controls. In the nested case-control study, patients with HCM who experienced OHCA were risk-set matched with controls with HCM and no OHCA at the index time. Analyses were performed between September 1 and November 30, 2025. First-time diagnosis of HCM. Time to OHCA from exposure or the matching date was the primary outcome. Risk estimates were determined using the Aalen-Johansen estimator. Association between covariates and OHCA was determined by conditional logistic regression. The cohort included a total of 29 240 individuals: 5901 patients with HCM (median age, 65 [IQR, 54-75] years; 3277 male [55.5%]) and 23&#x202f;339 matched controls (median age, 65 [IQR, 55-75] years; 12 982 male [55.6%]). In the group aged 61 to 85 years, the 10-year risk of OHCA was 4.3% (95% CI, 3.4%-5.1%) in patients and 3.3% (95% CI, 3.0%-3.7%) in controls. In the group aged 18 to 60 years, the 10-year risk was 2.8% (95% CI, 1.9%-3.7%) in patients and 1.5% (95% CI, 1.2%-1.8%) in controls. The nested case-control study included 250 cases with HCM and OHCA (167 male [66.8%]; median age, 68 [IQR, 59-76] years) and 1000 controls with HCM and no OHCA (668 male [66.8%]; median age, 68 [IQR, 59-76] years). Heart failure, both recent and longer term, was associated with an increased rate of OHCA (hazard ratio, 3.63 [95% CI, 1.55-8.50] and 2.82 [95% CI, 1.88-4.22], respectively). The findings of this cohort study suggest that HCM was associated with an increased risk of OHCA in people aged 18 to 85 years. The rate of OHCA was associated with heart failure, underscoring the need for improved risk stratification to optimize primary prevention.