heart failure

Overview

Heart failure is a clinical syndrome in which the heart is unable to pump blood sufficiently to meet the body’s metabolic demands, or can do so only at the cost of elevated filling pressures. It is not a single disease, but a final common pathway of many cardiovascular and systemic disorders, including ischemic heart disease, arterial hypertension, valvular disease, cardiomyopathy, diabetes, chronic kidney disease, and atherosclerosis. Clinically, it is commonly classified by left ventricular ejection fraction into heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), reflecting different patterns of systolic and diastolic dysfunction.

Biologically, heart failure involves structural remodeling of the myocardium, neurohormonal activation, inflammation, metabolic dysregulation, mitochondrial dysfunction, and impaired calcium handling. These processes contribute to progressive ventricular dysfunction, exercise intolerance, congestion, arrhythmia risk, hospitalization, and mortality. Because heart failure is common, costly, and heterogeneous, it remains a major focus of translational research, precision medicine, and therapeutic development.

Focus of Latest Publications

Recent publications have focused on heart failure in several clinical and implementation settings, with particular attention to comorbidities, risk stratification, and care delivery. In primary care patients with heart failure in southern Sweden, investigators conducted a cross-sectional study in the HISS cohort to determine the prevalence of iron deficiency and its association with symptom severity, reflecting ongoing interest in a common comorbidity linked to reduced functional capacity, higher symptom burden, and increased hospitalization risk. Another population-based retrospective cohort study examined how type 2 diabetes mellitus relates to heart failure hospitalization patterns across demographic groups and heart failure subtypes, underscoring the importance of metabolic comorbidity in hospitalization risk.

Several studies addressed heart failure within broader cardiovascular risk frameworks. A nationwide cohort study evaluated whether the association between heart failure and ischemic stroke in patients with atrial fibrillation is age dependent. In the Atherosclerosis Risk in Communities Study, researchers assessed whether cardiovascular-kidney-metabolic syndrome staging, together with echocardiographic characteristics, predicts incident heart failure. In individuals with type 1 diabetes, another study investigated whether shrunken pore syndrome, defined by a discrepancy between cystatin C- and creatinine-based estimated glomerular filtration rate, is associated with heart failure and other cardiovascular outcomes.

Heart failure has also been examined in relation to interventions and care models. A multicenter retrospective cohort study evaluated the safety and effectiveness of metabolic and bariatric procedures, including surgical and endoscopic approaches, in individuals with and without heart failure. In Quebec, a qualitative report described implementation of a multidevice telemonitoring program for home-based nursing care in older adults with heart failure, with the stated aim of assessing feasibility, acceptability, and organizational conditions for implementation in public home care systems.

Drug development studies have likewise included heart failure populations. A population pharmacokinetic analysis of the novel myeloperoxidase inhibitor mitiperstat pooled data from five clinical trials, including a phase 2a study in patients with heart failure with preserved/mildly reduced ejection fraction. The model identified baseline body weight, disease status, Asian race, and baseline estimated glomerular filtration rate as significant covariates for apparent clearance, and age as a significant covariate for apparent central volume of distribution; exposure increased as estimated glomerular filtration rate declined, with severe renal impairment and lower body weight having the largest impact on exposure.