Background and Objectives: Clinical characteristics and outcomes in acute heart failure (AHF) vary by phenotype. We assessed phenotype-specific features, treatment patterns, and outcomes in a nationwide Korean cohort. Methods: The Korean Heart Failure III registry prospectively enrolled 7,351 AHF admissions at 47 hospitals. Among 6,777 patients with available left ventricular ejection fraction (EF), phenotypes were defined as heart failure with reduced EF (HFrEF, ≤40%), mildly reduced EF (HFmrEF,41–49%), or preserved EF (HFpEF, ≥50%). The primary endpoint was a 12-month composite of all-cause death or heart transplantation, evaluated from index admission and, among hospital survivors, from discharge. We used inverse probability weighting (multinomial generalized boosted models with stabilized, trimmed weights) and weighted Cox proportional-hazards models to estimate hazard ratios (HRs). Results: Phenotype distribution was 58.9% HFrEF, 13.6% HFmrEF, and 27.5% HFpEF. Crude 12-month composite rates from index admission were 13.4% (HFrEF), 12.7% (HFmrEF), and 16.8% (HFpEF). After weighting, from index admission, HFmrEF (HR, 0.892; 95% confidence interval [CI], 0.731–1.088) and HFpEF (HR, 1.101; 95% CI, 0.939–1.291) did not differ from HFrEF; from discharge, HFpEF had modestly higher risk (HR, 1.207; 95% CI, 1.008–1.445) whereas HFmrEF did not (HR, 1.039; 95% CI, 0.844–1.279). Hyponatremia and chronic kidney disease were consistent adverse markers, while angiotensin-converting enzyme inhibitor/ angiotensin II receptor blocker use at discharge was protective. Conclusions Across the EF spectrum, phenotypes showed distinct profiles and risk. Postdischarge risk was modestly higher in HFpEF, supporting phenotype-tailored care and systematic discharge optimization in Korean patients with AHF.

Background and Objectives: We evaluated 20-year trends in heart failure (HF) epidemiology in Korea to quantify changes in its burden from 2002 to 2023. Methods: A nationwide analysis was conducted using a random 50% sample from the Korean National Health Information Database linked to mortality records (2002–2023). HF was defined using diagnostic codes recorded as a primary or secondary condition. We calculated crude and age-standardized rates of prevalence, incidence, hospitalization, and mortality. Survival was assessed using the Kaplan–Meier method, stratified by inpatient versus outpatient diagnosis.Trends in heart transplantation and left ventricular assist device implantations were also examined. Results: By 2023, approximately 1,750,228 individuals had HF (3.41% prevalence). The age-standardized prevalence has more than doubled from 2002 to 2023. The crude incidence increased over time; the age-standardized incidence remained stable in men and declined in women.Hospitalization rates for any cause or secondary HF diagnoses have increased substantially, whereas primary HF hospitalization rates have remained relatively stable. The annual mortality rate in patients with HF was approximately 6.0% in 2023, being markedly higher in older adults.Although short-term survival has improved, particularly in hospitalized patients, long-term survival remains limited. Use of advanced therapies significantly increased. Conclusions The burden of HF in Korea has increased substantially over the past two decades, driven primarily by population aging and improved survival rather than increasing age-adjusted incidence. Despite therapeutic advances, hospitalization and long-term mortality rates remain high, highlighting the need for comprehensive HF strategies in aging societies.

Heart failure with preserved ejection fraction (HFpEF) represents approximately half of all heart failure cases and poses a growing global health challenge driven by an ageing population and an increasing comorbidity burden. Once regarded as a condition without effective, evidence-based therapy, HFpEF has undergone a paradigm shift in recent years. Advances in the understanding of its complex pathophysiology have highlighted the multifactorial interplay between systemic inflammation, endothelial dysfunction, and metabolic derangements. The introduction of sodium-glucose cotransporter 2 inhibitors has transformed the HFpEF therapeutic landscape, following large-scale trials such as EMPEROR-Preserved and DELIVER demonstrating consistent reductions in mortality/morbidity in this patient population. More recently, the non-steroidal mineralocorticoid receptor antagonist finerenone, tested in the FINEARTS-HF trial, was also shown to improve mortality/morbidity in HFpEF, marking a further milestone in disease-modifying therapy. Further, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and a dual gastric inhibitory polypeptide analogue/GLP-1 RA (tirzepatide) have shown to reduce body weight and improve quality of life and mortality/morbidity in the obese-HFpEF phenotype, suggesting the need of additional tailoring of HFpEF therapy based on specific patient profiles. Despite these advances, HFpEF remains a frequently underdiagnosed syndrome, with diagnostic uncertainty often delaying therapy. Comprehensive management of comorbidities and systematic implementation of guideline-directed medical therapy remain crucial to improve patient outcomes.This narrative review provides an updated overview of the pathophysiological mechanisms, diagnostic approaches, and evolving pharmacological strategies shaping the modern management of HFpEF.

Heart failure (HF) prevalence and associated socio-economic costs have risen rapidly in Korea, creating urgent demand for a national, standardized prospective registry to support quality monitoring, outcome comparison, and real-world evidence. Standardized data definitions are essential for valid comparisons across studies and healthcare settings. We created a unified national HF cohort by integrating the two largest Korean registries, KorAHF (2011–2014;n=5,625) and KorHF III (2018–2023; n=7,351), yielding 12,976 hospitalized HF patients. Because heterogeneous variable definitions impeded direct comparisons, we implemented a harmonization pipeline across demographic, clinical, imaging, biomarker, therapeutic, and outcome domains, aligned with international standards and reinforced by systematic data quality checks.A multidisciplinary panel then conducted a structured decision process to produce the Korean HF Standard Dataset, a tiered and interoperable variable set spanning six domains: demographics, presentation at admission, in-hospital events and comorbidities, discharge status, outpatient follow-up, and readmission events. This integrated platform and standardized variables enable precise identification of HF patient phenotypes and prognostic factors, establishing an evidence-based foundation for disease management. This supports an analysis of temporal changes in treatment patterns and outcomes, generates data to inform future clinical practice guidelines, and provides a practical basis for planning large, continuous, prospective HF registries. Furthermore, it also facilitates pragmatic, registry-based randomized clinical trials and unmet-needs assessments that can guide national health policy. Establishing a foundation for future linkage with national health databases, this platform will allow for enhanced accuracy, comparability, and representativeness, powering quality improvement initiatives and population-level monitoring of Korea’s growing HF burden.

Atrial fibrillation (AF) and heart failure (HF) are common, interdependent conditions that frequently coexist and amplify each other’s progression and adverse outcomes. Managing AF in patients with HF remains complex and requires individualized decisions regarding rhythm vs. rate control, anticoagulation, and comorbidity optimization. Recent randomized trials and updated guidelines have reshaped therapeutic paradigms, favoring early rhythm control in appropriately selected patients. The bidirectional AF-HF interplay involves shared pathophysiological mechanisms—neurohormonal activation, structural remodeling, and atrial myopathy—leading to progressive systolic and diastolic dysfunction. Identifying “in whom” rhythm control yields prognostic benefit is essential, especially among patients with reduced ejection fraction (EF) and those with symptomatic AF or tachycardia-induced cardiomyopathy.Catheter ablation has emerged as a preferred rhythm-control strategy in HF with reduced EF, supported by CASTLE-AF, RAFT-AF, EAST-AFNET 4 and recent meta-analyses showing improved survival and HF hospitalization rates. Novel pulsed-field ablation technologies may further enhance safety in this vulnerable population. Optimal timing (“when”) favors early intervention before advanced remodeling, while the choice of “how” depends on AF burden, HF phenotype, and comorbidities. Anticoagulation with direct oral anticoagulants remains central to reducing thromboembolic risk, with attention to renal function, frailty, and polypharmacy. This narrative review synthesizes current evidence and offers a pragmatic clinical algorithm for managing AF in HF, emphasizing integrated, multidisciplinary, and patient-centered care strategies.