Objective C-reactive protein (CRP) is associated with tnfavorable outcome in patients with acute ischemic syndromes and in patients with chronic stable angina. Elevated CRP levels suggestive of heightened inflammatory state in vascular conditions are often associated with elevated interleulin-6 (IL-6) levels. The aim of our study was to show the predictive importance of CRP and IL-6 levels in patients with ischemic stroke that has not been fully elucidated. Design We studied 647 consecutive elderly patients ( ＞ 65 years) with stroke who were documented with ischemic stroke, presence of significant carotid atherosclerosis and absence of atrial fibrillation. The study population included 150 patients (74 men, 76 women, mean age 74 ± 2). Patients underwent evaluation of high sensitive CRP and IL-6 levels at baseline, during hospitalization and at discharge. Results In-hospital mortality was 6%, 1 year mortality was 15% and a second cerebrovascular event occurred in 12% of patients. Those with inhospital events had significantly higher baseline CRP and IL-6 levels than patients without events (3.8 ± 1.1 vs 1.9±0.9 mg/L,P＜0.01 and 13.8±3.4 vs6.3±2.1 pg/ml, P＜0.01, respectively). Also CRP and IL-6 levels were significantly higher in those patients with an event within 3 months of discharge compared to patientswithout an event (3.6±1.3 vs 1.1±0.7 ing/L, P＜0.01 and 14.2±3.7 vs5.4±1.6 pg/ml, P＜0.01,respectively). Both base line CRP levels and IL-6 were predictive of events both in-hospital and after 3 months while CRP and IL-6 levels at baseline were not associated with a poor 1 year prognosis. Elevated ClRP levels were associated with an unfavorable outcome only when IL-6 levels were also elevated. In a stepwise multivariate analysis IL-6 level was a stronger predictor of outcome than CRP. Conclusions In conclnsion, elevated CRP and IL-6 levels may identify elderly patients at increased medium term risk, but do not predict one year events in this subset of patients. CRP levels predict events only when they are coupled with IL-6 levels.

Frailty is highly prevalent among patients with heart failure (HF) and independently predicts adverse outcomes. However, optimal frailty definitions, assessments, and management in HF remain unclear. Frailty is common in HF, affecting up to 80% of patients depending on population characteristics. Even pre-frailty doubles mortality risk versus robust patients. Frailty worsens HF prognosis through systemic inflammation, neurohormonal changes, sarcopenia, and micronutrient deficiency. Simple screening tools like gait speed and grip strength predict outcomes but lack HF-specificity. Comprehensive geriatric assessment is ideal but not always feasible. Exercise, nutrition, poly-pharmacy management, and multidisciplinary care models can help stablize frailty components and improve patient-centred outcomes. Frailty frequently coexists with and exacerbates HF. Routine frailty screening should guide supportive interventions to optimize physical, cognitive, and psychosocial health. Further research on HF-specific frailty assessment tools and interventions is warranted to reduce this dual burden.

Heart failure with mid-range ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) represent over half of heart failure cases but lack proven effective therapies beyond sodium-glucose cotransporter 2 inhibitor and diuretics. HFmrEF and HFpEF are heterogeneous conditions requiring precision phenotyping to enable tailored therapies. This review covers concepts on precision medicine approaches for HFmrEF and HFpEF. Areas discussed include HFmrEF mechanisms, anti-inflammatory and antifibrotic treatments for obesity-related HFpEF, If inhibition for HFpEF with atrial fibrillation, and mineralocorticoid receptor antagonism for chronic kidney disease-HFpEF. Incorporating precision phenotyping and matched interventions in HFmrEF and HFpEF trials will further advance therapy compared to blanket approaches.

The prevalence of heart failure (HF) is increasing in many regions of the world, particularly within the context of aging populations in many countries. The Heart Failure Society of America (HFSA) sought to explore areas of global HF innovation with the goal of exchanging ideas and best practices internationally. The HFSA Annual Scientific Meeting included roundtable discussions focused on the challenges faced by each of the participating regions and sharing innovative solutions. Themes identified include the lack of high-quality region-specific HF registry data that is required to accurately define patient needs and to facilitate outcome metrics; the tension between providing care that is accessible to the patient vs. concentrating highly-specialized care within tertiary centers; the need to accredit and coordinate HF care across a spectrum of healthcare delivery centers within regions; opportunities to improve the prevention and timely diagnosis of HF to enhance population outcomes, especially in communities facing healthcare disparities; and the evolution of multidisciplinary team-based care, particularly in optimizing access to guideline-directed medical therapies. This article summarizes the major themes that emerged during the roundtable sessions.