Guidelines recommend prompt diagnosis of suspected heart failure in people with elevated N-terminal pro b-type natriuretic peptide (NT-proBNP). Early diagnosis of heart failure improves patient outcomes, however diagnosis is complex and can often be delayed. Digital platforms can provide clinicians with greater access to information with which to diagnose heart failure, improving on standard diagnostic pathways. We modelled the potential cost-effectiveness of a digital pathway, adapting the UK NICE guideline (NG106) cost-effectiveness model to evaluate the impact of potentially speedier diagnosis and treatment of heart failure. Posited reductions in time to treatment were modelled to reduce short-term mortality and generate approximately 0.056 incremental quality adjusted life-years over a lifetime horizon. Additional costs arose from earlier heart failure treatment, resulting in a cost per quality adjusted life-year of £5,882 (95

BACKGROUND:Cancer and heart failure (HF) frequently coexist due to population ageing and improved survival for both conditions. HF is a well-recognised complication of oncologic therapies and a potential association between HF and subsequent cancer incidence has been recently noticed. We therefore conducted a meta-analysis to quantify cancer incidence and mortality in patients with and without HF. METHODS:Databases were searched from inception to 15 February 2026. Data from observational studies and randomised trials on individuals with and without HF and reporting cancer incidence and/or mortality during follow-up were included. The main outcome of interest was the incidence of any cancer; secondary outcomes included site-specific cancer incidence (lung, colorectal, breast, and prostate) and all-cause, cardiovascular, and cancer-related mortality. RESULTS:Twelve studies comprising 8,979,195 individuals were included. HF was associated with a higher incidence of cancer (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.14-1.54), with substantial heterogeneity (I2 = 99.7%). Cancer site-specific analyses showed increased incidences of lung (HR 1.70, 95% CI 1.26-2.29), colorectal (HR 1.28, 95% CI 1.11-1.48), and breast (HR 1.19, 95% CI 1.04-1.37), but not prostate, cancer. Effect estimates varied according to analytical strategy: matched HF and non-HF cohorts reported higher risk estimates than those using covariate adjustment without matching. Mortality data were sparse and heterogeneous. CONCLUSIONS:HF is associated with a higher incidence of cancer, although with marked heterogeneity among studies and cancer types. Mortality and cause of death were rarely reported. The observed HF-cancer association is influenced by statistical methodology, shared risk factors, differences in surveillance intensity and cancer type, that confound analyses investigating possible causal biological links. More granular and harmonised studies are required.

Introduction and Objective: Heart failure (HF) is a frequently unrecognized complication in people living with diabetes. Clinical practice guidelines recommend screening for HF using natriuretic peptide testing. We examined the performance of the AHA PREVENT risk model to detect unrecognized HF in a randomized trial of NT-proBNP-based screening in patients with diabetes and risk factors for HF. Methods: TARTAN-HF (NCT05705869) randomized community-based participants (n=706) with an established diagnosis of diabetes and risk factors for HF to a screening strategy of NT-proBNP testing followed by echocardiography if NT-proBNP was elevated (≥125pg/mL) or to usual care. Patients with known HF were excluded. All HF diagnoses were made in accordance with the 2021 ESC HF guidelines. In this exploratory analysis, we calculated the AHA PREVENT 10-year risk of HF in participants randomized to screening with complete data for risk model variables. Results: The AHA PREVENT 10-year HF risk was calculated in 335 of the 354 (95%) randomized to screening. Median predicted risk was 20.8% (IQR 13.5-29.2). Among participants with NT-proBNP ≥125 pg/mL (n=168), median predicted risk was higher than in those with NT-proBNP <125 pg/mL (23.2% [17.3-33.2] vs 17.1% [11.1-23.1]). Of the 168 (48%) with an elevated NT-proBNP, 84 (50%) were diagnosed with HF following echocardiography; predicted risk was higher in those with HF than in those without HF (median 26.5% vs. 21.1%). Restricting echocardiography to participants with NT-proBNP ≥125 pg/mL who were classified as high risk by the AHA PREVENT score (≥20%) would have reduced echocardiography use by 30% but would have missed 12 of 84 HF cases (sensitivity 86%). Conclusion: In patients with diabetes undergoing NT-proBNP-based screening, the AHA PREVENT risk model identified individuals at higher risk of HF and may improve screening efficiency by reducing the number of echocardiograms required. Disclosure D.R. Taylor-Sweet: None. M. Petrie: Consultant; Current; AstraZeneca. G. McKinley: None. L.M. McGlynn: None. R.T. Campbell: Research Support; Current; Roche Diagnostics, SQ Innovations. A. McConnachie: None. J.J. Mcmurray: Speaker's Bureau; Current; Imagica Health, Intas Pharmaceuticals Ltd., J.B. Chemicals & Pharma. Ltd., Lupin Pharmaceuticals, Inc., ProAdwise Communications, Sun Pharmaceutical Industries Ltd., Translational Medicine Academy. Other - Director; Current; Global Clinical Trial Partners Ltd. Other - payments through Glasgow University from work on clinical trials, consulting and grants; Current; Alnylam Pharmaceuticals, Inc., Amgen Inc., AstraZeneca, Bayer AG, Cardurion Pharmaceuticals, Cytokinetics Inc., Novartis AG, British Heart Foundation, National Institutes of Health, SQ Innovations. Consultant; Current; AstraZeneca, AnaCardio Pharma, Bayer AG, Cardurion Pharma., Novartis AG, Alkem Metabolics. Speaker's Bureau; Current; Canadian Me3dical and Surgical Knowledge, AstraZeneca, Emcure Pharma., Eris Lifesciences Ltd., European Academy of CME, Hikma Pharma. C.S. Lam: Research Support; Current; Novo Nordisk A/S, Roche Diagnostics. Consultant; Current; Alnylam Pharmaceuticals, Inc., Applied Therapeutics, AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Boston Scientific Corporation, Bristol-Myers Squibb Company, CPC Clinical Research, Cytokinetics Inc., Eli Lilly and Company, Impulse Dynamics, Janssen Research & Development, LLC, Medscape, Merck & Co., Inc., Novartis AG, Pfizer Inc., Radcliffe Group, Roche Pharmaceuticals. Other - Consultant, Co-founder and Non-Executive Director; Current; Us2.ai. Consultant; Current; Anacardio AB, Corteria, Intellia Therapeutics. K. Docherty: Consultant; Current; AstraZeneca. Advisory Panel; Current; Eli Lilly and Company. Advisory Panel; Ended; Us2.ai, Bayer AG. Speaker's Bureau; Ended; Roche Diagnostics. Advisory Panel; Ended; Abbott. Research Support; Current; Roche Diagnostics. Research Support; Ended; Boehringer Ingelheim International GmbH. Funding AzetraZenica, Roche Diagnostics, Us2.ai

INTRODUCTION:Many patients with heart failure (HF) have or develop atrial fibrillation (AF), which may contribute to worsening symptoms, hospitalisations and mortality. Whether catheter ablation improves outcomes in patients with HF and AF receiving guideline-recommended pharmacological therapy (GRPT) is controversial. AIMS:A systematic review and meta-analysis of relevant randomised controlled trials (RCT)s on the role of catheter ablation in patients with AF and HF. METHODS:Public databases for trials published prior to 17th March 2025 and investigating the effects of catheter ablation on morbidity and mortality in patients with HF and AF were searched. Outcomes of interest were all-cause and cardiovascular mortality, adverse events due to HF or AF, changes in left ventricular ejection fraction (LVEF), 6-Minute Walking Distance (6-MWD) and Minnesota Living With Heart Failure Questionnaire (MLWHFQ) scores. RESULTS:Altogether, thirteen RCTs including 2,490 patients (predominantly aged <65 years; of whom 73% were men and 79% reported persistent AF) were identified. Blinding of intervention was not attempted. Only three RCTs assessed the effect of catheter ablation in patients with preserved LVEF. Overall, compared to GRPT alone, catheter ablation was associated with lower all-cause mortality (hazard ratio [HR]: 0.58; 95% confidence interval [CI]: 0.44-0.76), cardiovascular death (HR: 0.52; 95% CI: 0.36-0.74) and adverse events related to HF or AF (HR: 0.69; 95% CI: 0.53-089). In addition, catheter ablation improved LVEF (+6% mean difference (MD)[95% CI: +4% to +9%]) and MLWHFQ (-12 points MD [95% CI: -18 points to -6 points]), with a trend to enhanced 6-MWD (+18 meters MD [95% CI: -1 meter to +38 meters]). CONCLUSIONS:For a selected group of patients with chronic HF and AF enrolled in un-blinded RCTs, catheter ablation improved cardiac function, wellbeing and outcomes, including all-cause mortality. Further RCTs are required to determine whether the benefits of catheter ablation extend to a broader population of patients at higher risk of procedural failure and recurrent AF.

AIMS:Despite improvements in post-acute myocardial infarction (AMI) care, the risk of subsequent cardiovascular (CV) events remains substantial, particularly heart failure (HF) in patients with left ventricular systolic dysfunction (LVSD) and/or pulmonary congestion. METHODS:The PARADISE-MI trial randomized 5661 patients with AMI complicated by LVSD and/or pulmonary congestion to sacubitril/valsartan (97/103 mg bid) or ramipril (5 mg bid) at a mean of 4 days post-AMI. This post hoc analysis described the timing and distribution of CV events, and compared treatment effects in early (≤ 3 months) and late (> 3 months) post-AMI periods. RESULTS:Post-AMI, CV events peaked early; HF was the most frequent (16.2/100 patient-years (py)), followed by CV death (11.6/100 py) and recurrent MI (10.9/100 py). Later, HF remained predominant (3.2/100 py vs. 2.6/100 py for MI, p=0.008; CV death 2.1/100 py). Early post-AMI, patients with HF or recurrent MI shared similar profiles. Later, HF patients were predominantly older and female, with greater pulmonary congestion and lower eGFR; recurrent MI patients had more frequent history of coronary revascularization. Only sacubitril/valsartan showed a favorable influence late post-AMI (HR 0.76, 95% CI 0.60-1.00, p=0.05) and expanded CV composite outcome (CV death, HF events, recurrent MI, hospitalization for angina, or post-randomization coronary revascularization) benefit over the trial (HR=0.87, 95% CI 0.77-0.97, p=0.012). CONCLUSIONS:Post-AMI, HF predominates both early and late among CV events. Compared with ramipril, sacubitril/valsartan was associated with a possible late reduction in recurrent MI and a modest decrease in an expanded CV composite outcome that merits further investigation.

Introduction Heart failure (HF) is a common sequela of diabetes and obesity. Glucagon-like peptide-1 (GLP-1) receptor agonists may prevent HF events. This meta-analysis estimates absolute risk reduction (ARR) and number needed to treat (NNT) for GLP-1 receptor agonists to prevent one HF event in patients with type 2 diabetes and/or obesity, including those without baseline HF.Methods The Medline, Embase, and Cochrane Central databases were searched to 04 April 2025 for placebo-controlled randomized controlled trials (RCTs) of GLP-1 receptor agonists in a type 2 diabetes and/or obesity indication with a prespecified HF event endpoint. Random effects meta-analysis using the Mantel-Haenszel Method was performed to synthesize risk ratios (RR), ARRs, and NNTs with 95% confidence intervals (CI).Results Twelve placebo-controlled RCTs involving 95 023 patients were included. GLP-1 receptor agonists reduced HF events by 12% (RR 0.88, 95% CI 0.82-0.95; ARR 0.42%, 95% CI 0.17%-0.62%; NNT 238, 95% CI 161-588), and, in those without baseline HF, by 19% (RR 0.81, 95% CI 0.72-0.90; ARR 0.60%, 95% CI 0.32%-0.89%; NNT 167, 95% CI 113-313). Semaglutide reduced the risk of HF events by 16% (RR 0.84, 95% CI 0.74-0.95; ARR 0.62%, 95% CI 0.19%-1.00%; NNT 161, 95% CI 100-526), and by 31% in those without baseline HF (RR 0.69, 95% CI 0.55-0.88; ARR 1.25%, 95% CI 0.48%-1.82%; NNT 80, 95% CI 55-208).Conclusion GLP-1 receptor agonists have limited absolute benefit for preventing HF events in patients with type 2 diabetes and/or obesity, including in those without baseline HF.Systematic review registration PROSPERO: CRD420251074882

Heart failure with reduced ejection fraction (HFrEF) imposes a significant clinical burden on patients and a major economic burden on healthcare systems. In HFrEF, mineralocorticoid receptor antagonists (MRAs) constitute a cornerstone of guideline-directed medical therapy (GDMT) reducing both mortality and hospitalisation. Their use in practice remains suboptimal, largely because of physicians' concerns about adverse events, particularly hyperkalaemia, which may deprive eligible patients of benefit. Only the steroidal MRAs spironolactone and eplerenone are approved for HFrEF, and this consensus document is restricted to these agents. We summarise contemporary evidence across multiple domains related to MRA therapy in HFrEF, including pharmacoepidemiology, the role of biomarkers in predicting outcomes and response to MRA, the pathological role of aldosterone and the pharmacology and clinical efficacy of steroidal MRAs. Practical, evidence-based guidance is provided on the prevention and management of hyperkalaemia, the timing of MRA initiation, and strategies to overcome barriers to MRA use. The positioning of MRAs in current guidelines is outlined to reinforce their central role in HFrEF. The process of consensus finding was started in April 2025 with a core group by online conference. We searched PubMed with the terms "MRA, eplerenone and heart failure with reduced ejection fraction". Articles published in English with no date restriction were considered. The final manuscript passed two rounds of final approval by all authors. As a result, this consensus statement advocates proactive, evidence-based approaches to optimise MRA use to improve outcomes. These recommendations aim to mitigate the persistent underuse of MRAs in clinical practice.

BACKGROUND AND AIMS:The risk of heart failure progression or mortality in patients with peri-partum cardiomyopathy (PPCM) during subsequent pregnancies (SSPs) is a significant concern for patients, their families, and healthcare providers. However, there is limited contemporary, prospective data on SSP outcomes in PPCM patients from diverse ethnic and sociodemographic groups. This study aimed to assess maternal and neonatal outcomes in PPCM patients undergoing SSPs. METHODS:This is a sub-study on PPCM and SSPs of the global European Society of Cardiology PPCM Registry that recruited patients from 2012 to 2023. Maternal and neonatal outcomes were reported. RESULTS:From 332 patients with PPCM, there were 98 SSPs among 73 women. Of these, 25 (26%) SSPs ended prematurely due to therapeutic termination (20/25), miscarriage (4/25), and stillbirth (1/25). The median follow-up from the end of the SSP was 198 days (inter-quartile range 160-240). Left ventricular ejection fraction (LVEF) was persistently reduced to <50% prior to the SSP in 26% of patients, with only 6% having an LVEF <40%. Patient characteristics were similar, irrespective of SSP baseline LVEF. Clinical worsening [composite of all-cause death, cardiovascular rehospitalization, or decline in LVEF ≥10% (percentage points) and to <50%] occurred in 20% SSPs, with 2% all-cause maternal mortality. Signs/symptoms of heart failure and worsening of New York Heart Association class occurred in 26% and 22% of SSPs, respectively. At follow-up, the mean LVEF was 50% (±12%), and in 69% of SSPs, the LVEF was ≥50%. African women had similar outcome as the other ethnic groups. Pre-term delivery occurred in 24% of SSPs, 20% of babies were of low birth weight, and there was 3% all-cause neonatal mortality. Compared with women with SSP baseline LVEF <50%, fewer women with LVEF ≥50% were on heart failure pharmacotherapies prior to the SSP, and in this group of women, there was a significant decline in LVEF. CONCLUSIONS:Maternal morbidity and mortality rates were lower than anticipated. Baseline LVEF <50% was not associated with an increased frequency of adverse maternal outcomes, and no further decline in LVEF was observed in this group. In contrast, women with SSPs and a baseline LVEF ≥50% experienced a decline in LVEF, potentially attributable to reduced use of heart failure pharmacotherapy during pregnancy and the post-partum period. Therapeutic termination was performed in approximately a fifth of cases. The findings suggest that reclassification of a SSP with persisting mild left ventricular impairment from modified World Health Organization (mWHO) Class IV (contraindicated) to mWHO III may be considered, while remaining under the care of an experienced medical team and with appropriate pharmacological management.

Despite major advancements in heart failure (HF) management and guideline recommendations over the past two decades, real-world evidence highlights suboptimal implementation of guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF). Low blood pressure (BP) is common in HFrEF patients and represents a major perceived barrier to implementing life-saving treatments in clinical practice, as physicians are often concerned about symptomatic hypotension and its consequences. Although low BP can be seen in those hospitalized with signs of shock, the most common scenario involves non-severe, asymptomatic hypotension in patients receiving foundational therapy for HFrEF, where premature down-titration or discontinuation of GDMT should be avoided. This clinical consensus statement provides a comprehensive overview of low BP in HFrEF, including its definition, risk factors, and effects of HF therapies on BP. We propose management pathways to optimize HFrEF treatment in the context of low BP, ultimately aiming to improve patient outcomes.

Episodes of worsening heart failure (HF) are a major cause of unplanned hospitalizations. Their onset is usually preceded by an early increase in intracardiac pressures with subsequent worsening of symptoms due to congestion. Implantable devices allowing daily remote pulmonary artery pressure (PAP) monitoring are useful to identify early haemodynamic changes so that medical therapy can be adjusted at an early stage, before symptom onset, and HF-related hospitalizations be prevented. Second, the use of these devices may help to maintain clinical stability keeping PAP in the target range on a day-to-day basis. The CardioMEMS system allows remote PAP monitoring, and PAP-guided medical therapy has reduced HF-related hospitalizations in prospective, randomized, controlled clinical trials in symptomatic patients with HF, independent of their left ventricular ejection fraction. The safety and feasibility of other devices, like the Cordella implantable PAP sensor, have also been demonstrated and clinical usefulness in larger patient populations is currently being assessed in several trials. Most of the studies testing remote PAP monitoring were reported after the 2021 European Society of Cardiology HF guidelines. An update of the clinical significance and potential implications for clinical practice of these systems seems therefore warranted. The aim of this clinical consensus statement is to summarize current knowledge on remote PAP-guided management of patients with HF, with a special focus on current evidence from clinical trials, potential impact on clinical practice and management aspects.

BACKGROUND:Inflammation may play an important pathophysiological role in the development and progression of heart failure (HF). Interleukin (IL)-6 is a circulating cytokine and is the main regulator of the release of C-reactive protein (CRP). OBJECTIVES:The authors examined the association between IL-6 and high-sensitivity (hs)-CRP and outcomes in patients with HFrEF in the DAPA-HF trial and their relationship with the effect of dapagliflozin. METHODS:Inclusion criteria included: 1) NYHA functional class II-IV; 2) left ventricular ejection fraction ≤40%; 3) elevated N-terminal pro-B-type natriuretic peptide; and 4) estimated glomerular filtration rate ≥30 mL/min/1.73 m2. The primary outcome was a composite of a worsening HF event or cardiovascular death. IL-6 and hs-CRP were measured at baseline and 12 months (Roche Diagnostics). The associations between IL-6 and hs-CRP and outcomes were adjusted for known prognostic variables, including NT-proBNP. RESULTS:Among 2,940 patients, median IL-6 and hs-CRP at baseline were 6.01 pg/mL (Q1-Q3: 4.18-9.28 pg/mL) and 2.05 mg/L (Q1-Q3: 0.83-4.9 mg/L), respectively. Baseline IL-6 tertiles (T) were: T1 ≤4.72 pg/mL; T2 4.73-7.89 pg/mL; and T3 ≥7.90 pg/mL. The adjusted risks of the primary outcome relative to T1 were as follows: T2 = HR 1.34 (95% CI: 1.04-1.73) and T3 = HR 1.80 (95% CI: 1.41-2.31). A rise in IL-6 between baseline and 12 months was associated with worse outcomes. The beneficial effect of dapagliflozin on the primary outcome was consistent regardless of IL-6 concentration (continuous interaction P = 0.57), with similar results for hs-CRP. Dapagliflozin did not reduce IL-6 or hs-CRP at 12 months. CONCLUSIONS:In DAPA-HF, elevated IL-6 and hs-CRP levels were each associated with the risk of worsening HF or cardiovascular death. Dapagliflozin reduced the risk of adverse outcomes regardless of baseline IL-6 or hs-CRP. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124).

Heart failure (HF) is a heterogeneous and dynamic syndrome characterized by progressive pathophysiological alterations, variable clinical trajectories, and differential responses to therapeutic interventions. The concept of HF with improved ejection fraction (HFimpEF) underscores this complexity, identifying patients who exhibit an increase in left ventricular ejection fraction (LVEF) following time and/or pharmacological and device-based therapies. However, the distinction between improvement, remission, and recovery remains inconsistently defined and is primarily LVEF-centric, lacking comprehensive assessment of structural, functional, and symptomatic HF status. This expert consensus document delineates HF trajectories, examines factors reflecting HF improvement beyond recovery of LVEF, and explores the prognostic implications of these phenotypic transitions. Emphasis is placed on the necessity of continued guideline-directed medical and device therapy to minimize the risk of relapse. While a subset of patients attains sustained myocardial and clinical recovery, others remain susceptible to relapse, necessitating individualized monitoring and long-term management. Persistent knowledge gaps regarding the safety and feasibility of treatment de-escalation, the role of genetic predisposition, and optimal therapeutic strategies underscore the need for further research to refine risk stratification and evidence-based decision-making in HFimpEF.

Background: About half of patients with heart failure with mildly reduced or preserved ejection fraction (HFpEF) have type 2 diabetes. In the STEP-HFpEF DM trial of adults with obesity-related HFpEF and type 2 diabetes, subcutaneous once weekly semaglutide 24 mg conferred improvements in heart failure-related symptoms and physical limitations, bodyweight, and other heart failure outcomes. We aimed to determine whether these effects of semaglutide differ according to baseline HbA(1c). Methods: STEP-HFpEF DM, a double-blind, randomised, placebo-controlled trial conducted at 108 clinical research sites across 16 countries in Asia, Europe, and North and South America, included individuals aged 18 years or older with documented HFpEF (left ventricular ejection fraction >= 45%), type 2 diabetes, and obesity (BMI >= 30 kg/m(2)). Participants were randomly assigned (1:1), with a block size of four within each stratum using an interactive web response system, stratified by baseline BMI (<35 kg/m(2)vs >= 35 kg/m(2)), to receive either semaglutide 24 mg or placebo subcutaneously. The effects of semaglutide versus placebo on the efficacy endpoints were evaluated by HbA(1c) categories at baseline: low (<65%; <48 mmol/mol), medium (65% to <75%; 48 mmol/mol to <58 mmol/mol), and high (>= 75%; >= 58 mmol/mol). The dual primary endpoints were change in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) and bodyweight percentage from baseline to 52 weeks and were assessed in all randomly assigned participants by intention to treat. Hypoglycaemia events were also analysed to assess safety in all randomly assigned participants who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT04916470. Findings: Between June 27, 2021 and Sept 2, 2022, 616 participants were enrolled and randomly assigned (mean age 684 years [SD 89]; 273 [44%] were female, 343 [56%] were male, and 519 [84%] were White). The low baseline HbA(1c) group included 227 participants (112 assigned to semaglutide and 115 to placebo), the medium baseline HbA(1c) group included 226 participants (124 assigned to semaglutide and 102 to placebo), and the high baseline HbA(1c) group included 163 participants (74 assigned to semaglutide and 89 to placebo). The median duration of follow-up in the overall trial was 401 days (IQR 400-405). The change in KCCQ-CSS from baseline to 52 weeks was 124 points (95% CI 88 to 160) with semaglutide versus 57 points (21 to 92) with placebo (mean difference 67 points [16 to 118]) in the low baseline HbA(1c) group, 145 points (110 to 179) versus 85 points (48 to 122; 60 points [09 to 111]) in the medium baseline HbA(1c) group, and 145 points (100 to 190) versus 48 points (07 to 89; 96 points [35 to 157]) in the high baseline HbA(1c) group (p(interaction)=064; p(trend)=046). The change in bodyweight percentage from baseline to 52 weeks was -108 (95% CI -121 to -95) with semaglutide versus -33% (-46 to -20) with placebo (mean difference -75% [-94 to -56]) in the low baseline HbA(1c) group, -96% (-108 to -83) versus -33% (-47 to -19; -63 [-82 to -44]) in the medium baseline HbA(1c) group, and -86% (-102 to -70) versus -36% (-52 to -21; -50 [-72 to -27]) in the high baseline HbA(1c) group (p(interaction)=022; p(trend)=0083). Hypoglycaemia events occurred in 30 (10%) of 310 participants (70 events; 229 events per 100 person-years) in the semaglutide group compared with 21 (7%) of 306 participants in the placebo group (90 events; 295 events per 100 person-years).

BACKGROUND:N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with heart failure (HF) hospitalizations and death when measured during a myocardial infarction (MI). However, NT-proBNP concentrations change following the initial ischemic insult and less is known about the prognostic importance of NT-proBNP in the early convalescent phase. METHODS:PARADISE-MI randomized 5661 patients with MI complicated by LVEF ≤40% and/or pulmonary congestion to sacubitril/valsartan or ramipril. Patients with available week 2 NT-proBNP concentrations and without-incident HF between randomization and week 2 (n = 1062) were analyzed. Associations of week 2 NT-proBNP with subsequent clinical outcomes were evaluated in landmark analyses using Cox models adjusted for clinical characteristics, including LVEF, baseline NT-proBNP and atrial fibrillation. RESULTS:Median 2-week NT-proBNP concentration was 1391 [676-2507] ng/L. Patients in the highest NT-proBNP quartile (≥2507 ng/L) were older, had lower left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR), higher Killip class, and more atrial fibrillation. Higher NT-proBNP concentrations were independently associated with greater risk of cardiovascular death or incident HF (adjusted hazard ratio [aHR], 1.65 per doubling of NT-proBNP; 95% confidence interval [CI], 1.31-2.09), HF hospitalization (aHR, 1.87; 95% CI, 1.38-2.54), recurrent myocardial infarction (aHR, 1.46; 95% CI, 1.09-1.95) and all-cause death (aHR, 1.85; 95% CI, 1.35-2.53). CONCLUSIONS:Patients with elevated NT-proBNP concentrations approximately 2 weeks after a high-risk myocardial infarction are at heightened risk of incident HF, recurrent coronary events, and death independent of baseline NT-proBNP concentrations and clinical characteristics. Elevations in NT-proBNP concentrations in the early convalescent phase may assist in risk stratification and the identification of patients in need of more advanced preventive treatment approaches.