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.

Chronic heart failure (CHF) is frequently complicated by chronic kidney disease (CKD), a comorbidity that profoundly influences disease progression, therapeutic decision-making, and clinical outcomes. The management of CHF in patients with advanced CKD presents substantial challenges, often requiring dose adjustments or even discontinuation of standard therapies. Effective therapeutic strategies must prioritize cardiorenal protection during the early stages of disease progression. Recent advancements in pharmacotherapy, including angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists, have demonstrated remarkable dual cardiorenal protective effects. These therapies not only reduce the risk of de novo heart failure in high-risk populations and improve clinical outcomes in CHF patients, but also slow the progression of renal dysfunction by targeting critical pathophysiological processes, such as glomerular hyperfiltration, inflammation, ischemia, and endothelial dysfunction. Although transient declines in estimated glomerular filtration rate may occur upon initiating these agents, renal function typically stabilizes over time, facilitating sustained clinical benefits, particularly in patients with diabetes mellitus, albuminuric CKD, and CHF. This review focuses on the latest advancements in heart failure pharmacotherapy, emphasizing the cardiorenal protective mechanisms and clinical efficacy of novel therapeutic agents. It underscores the importance of bridging knowledge gaps and personalizing therapy to enhance cardiorenal benefits avoiding adverse effects.

Background and Objectives: Acute decompensated heart failure (ADHF) often necessitates invasive mechanical ventilation (MV) due to respiratory failure. Positive end-expiratory pressure (PEEP) is a critical component in MV management; however, the optimal PEEP level for patients with ADHF remains unclear. The High vErsus Low Positive end-expiratory pressure in mechanically ventilated patients with Acute Heart Failure (HELP-AHF) trial is a multicenter, open-label, randomized controlled study designed to compare the efficacy and safety of high versus low PEEP strategies in this population. Methods: A total of 120 patients with ADHF requiring MV within 24 hours of initiation will be randomized 1:1 to a high PEEP group (target: 10 cmH2 O) or a low PEEP group (target: 3 cmH2 O). Results: The primary outcome is ventilator-free days at day 28. Key secondary outcomes include in-hospital mortality, duration of intensive care unit and hospital stay, vasoactive-inotropic support, and rates of heart transplantation or left ventricular assist device implantation. Safety outcomes include hemodynamic instability requiring mechanical circulatory support, pulmonary complications, and weaning-related adverse events. Conclusions This HELP-AHF trial aims to provide valuable insights into optimal PEEP strategies in ADHF patients receiving invasive MV. Findings from this study have the potential to inform ventilatory management practices and improve outcomes in this high-risk population.

Background and Objectives: In chronic heart failure (HF), natriuretic peptide (NP) levels are higher in atrial fibrillation (AF) compared to sinus rhythm (SR). However, due to the loss of atrial contraction, AF patients are prone to hemodynamic decompensation at earlier stages.Since NP levels reflect disease severity, acutely decompensated AF patients may exhibit lower NP levels compared to SR patients, who retain greater hemodynamic reserve. Methods: We analyzed 5,048 patients with acute HF from the Korea Acute Heart Failure registry with available NP data. NP levels and echocardiographic parameters were compared between AF and SR patients. The association of NP levels with in-hospital and one-year mortality was also assessed according to cardiac rhythm. Results: Brain natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured in 2,027 and 3,021 patients, respectively. NP levels were lower in AF than in SR (median BNP, 740 vs. 1,044 pg/mL; median NT-proBNP, 4,420 vs. 5,198 pg/mL), particularly in HF with reduced or mildly reduced ejection fraction. A similar trend was observed regardless of HF onset or etiology. AF patients had smaller left ventricular (LV) end-diastolic diameter and larger left atrial size compared to SR patients. Higher NP tertiles were associated with increased in-hospital and one-year mortality in both groups. Conclusions In acute HF, NP levels are lower in AF than in SR. AF patients also exhibited smaller LV chamber sizes. Nevertheless, NP levels remain strong predictors of outcomes in both AF and SR patients.

Background and Objectives: Dose-dense anthracycline-based chemotherapy has emerged as a critical strategy in managing high-risk breast cancer, offering survival benefits through increased dose intensity or shortened intervals. While short-term studies report preserved left ventricular ejection fraction (LVEF), the long-term cardiotoxicity of such regimens, especially at accelerated intervals, remains inadequately explored. Aim of this study was to evaluate the long-term cardiac safety of dose-dense anthracycline-based chemotherapy compared to conventional protocols in patients with non-metastatic breast cancer. Methods: This retrospective study included 101 breast cancer patients treated at the National Center for Tumor Diseases, Heidelberg, between 2007 and 2014. Patients were classified into dose-dense (n=44) or conventional therapy (n=57) groups. Long-term follow-up (7–10 years post-treatment) comprised echocardiography with global longitudinal strain (GLS), electrocardiography, and cardiac biomarkers. Statistical analyses were conducted using Cox regression, and competing risks models. Results: Left ventricular systolic function was preserved in both groups, with no significant differences in LVEF (58.1±5.4% in the dose-dense group and 59.6±3.7% in the conventional therapy group, p=0.341) or GLS. Diastolic dysfunction affected 28.6% of the dose-dense group and 47.4% of the conventional group, with age (odds ratio [OR], 1.14 per year; p=0.038) and hypertension (OR, 10.50; p=0.011) emerging as key predictors. Only one case of anthracycline-induced heart failure was reported. Mortality was primarily tumor-related, highlighting limited cardiac contributions to overall survival. Conclusions Dose-dense anthracycline therapy demonstrated comparable long-term cardiac safety to conventional regimens, with preserved systolic function and minimal heart failure incidence. These findings underscore the importance of individualized risk assessment and comprehensive cardiac monitoring in breast cancer management.