Background and Aims To assess in-hospital and 1-year cause-specific outcomes in the contemporary European Society of Cardiology (ESC) Heart Failure (HF) III Registry.Methods Patients were enrolled in European or ESC affiliated countries and characterized in detail regarding clinical characteristics and cause-specific outcomes.Results Between 1 November 2018 and 31 December 2020, 10,162 patients were enrolled from 220 centres in 41 countries. Of these, 39% had acute HF ('AHF', age 70 [62-79] years, 36% women) and 61% had out-patient visit for HF ['out-patient HF', age 66 (58-75) years, 33% women]. Overall, 58% had HF with reduced ejection fraction (HFrEF), 17% HF with mildly reduced ejection fraction (HFmrEF), and 25% HF with preserved ejection fraction (HFpEF). In AHF, median [interquartile range (IQR)] duration of hospitalization was 9 (6-14) days, and 5.1% died in hospital (HFrEF 5.2%; HFmrEF 4.8%, HFpEF 3.4%). In AHF discharged alive and in out-patient HF, after a median (IQR) follow-up of 376 (360-432) days, all-cause, cardiovascular (CV), and unknown-cause mortality rates per 100 patient-years were as follows: AHF HFrEF: 19, 13, and 3.0 per 100 patient-years. The corresponding numbers were in AHF HFmrEF: 22, 11, and 6.3; AHF HFpEF: 16, 7.0, and 4.7; out-patient HFrEF: 6.6, 4.3, and 0.9; out-patient HFmrEF: 4.0, 2.6, and 0.8; out-patient HFpEF: 3.9, 1.7, and 1.2. At least one (re-)hospitalization for HF was experienced in 44% AHF HFrEF, 42% AHF HFmrEF, 36% AHF HFpEF, 21% out-patient HFrEF, 14% out-patient HFmrEF, and 18% out-patient HFpEF.Conclusions In HF in Europe and affiliated countries, in-hospital mortality was 5.1% and greater with lower ejection fraction. Among hospital survivors and out-patients over 1 year of follow-up, event rates per 100 patient-years varied for death, 3.9-22, CV death 1.7-13, and unknown cause of death 0.8-6.3. The percent of patients that were (re-)hospitalized for HF at least once over 1-year follow-up ranged 14-44% and was twice as high post-AHF compared with post-out-patient visit.

AIMS:Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recognized for their cardiovascular benefits. This systematic review and meta-analysis evaluated the impact of SGLT2i on heart failure (HF) outcomes in cancer patients and survivors, focusing on HF hospitalization and new HF diagnoses. METHODS AND RESULTS:A comprehensive search of PubMed, MEDLINE, and Embase via Ovid, and the Cochrane Library was conducted up to 5 June 2024, focusing on studies involving cancer patients and survivors treated with SGLT2i. The search criterion used was [(SGLT2) OR (Sodium glucose cotransporter 2 inhibitors) OR (canagliflozin) OR (dapagliflozin) OR (empagliflozin) OR (ertugliflozin) AND (cancer)]. The primary outcomes assessed were HF hospitalization and new HF diagnoses. The search yielded 1880 studies, from which 13 studies encompassing 88 273 patients were included. SGLT2i use reduced HF hospitalizations by 51% (RR 0.49, 95% CI 0.36-0.66, I² = 28%, P < 0.01) and new HF diagnoses by 71% (RR 0.29, 95% CI 0.10-0.87, I² = 71%). Multi-variate meta-regression analysis suggested that among breast cancer populations, studies with ≥50% of patients on anthracyclines exhibited a 99% reduction in HF hospitalization risk compared with similar studies that included <50% of patients on anthracyclines (RR 0.0085, 95% CI: 0.0001-0.2645, P = 0.0081). CONCLUSION:SGLT2i significantly lower the risk of HF hospitalization and new HF diagnoses among cancer patients and survivors, with particularly pronounced benefits in breast cancer patients receiving anthracycline-based chemotherapy. These findings support the need for prospective trials to further investigate the integration of SGLT2i into cancer patient management to enhance cardiovascular outcomes.

AIMS:Current guidelines recommend beta-blocker therapy after myocardial infarction (MI) regardless of left ventricular ejection fraction (LVEF). However, recent trials question their benefit in patients with preserved LVEF. No study has yet compared beta-blocker effects during the acute coronary syndrome (ACS) phase (≤1 year post-MI) vs. the chronic coronary syndrome (CCS) phase (>1 year). METHODS AND RESULTS:In this pre-specified landmark analysis of the REBOOT trial, we evaluated the effect of beta-blocker therapy on outcomes in two post-MI phases: the ACS period (first year; cohort 1, n = 8438) and the CCS period (>1 year, event-free patients with follow-up; cohort 2, n = 7783). The primary endpoint was all-cause death, nonfatal reinfarction, or heart failure hospitalization; secondary endpoints included individual and additional cardiovascular events. Among 623 primary outcome events, 238 occurred in the first year (28.9/1000 patient-years) and 385 thereafter (19.3/1000 patient-years). Secondary prevention use was generally high, but patients with early events had lower prescription rates than those with late events or no events. Beta-blockers were not associated with lower risk of the primary or component outcomes in either phase. A nonsignificant trend towards benefit of beta-blockers appeared during the first year in patients with mildly reduced LVEF (41-49%), whereas in the CCS phase, higher beta-blocker doses were associated with worse outcomes. CONCLUSION:In invasively treated MI patients with LVEF >40%, beta-blockers did not reduce adverse outcomes in either the ACS or CCS phases. These findings challenge their routine use in this population and support reconsidering current guidelines. Long-term beta-blocker users after MI may be candidates for deprescription.

Artificial intelligence is now embedded across the scientific research and publishing ecosystem, influencing discovery, analysis, knowledge translation, authorship, peer review, and editorial workflows. In cardiovascular and biomedical sciences, these developments offer substantial opportunities to accelerate knowledge generation, integrate complex datasets, and improve efficiency and consistency. At the same time, they introduce new risks related to bias, transparency, data integrity, and authorship responsibility, potentially endangering trust in the scientific record. This commentary examines the evolving role of AI in biomedical publishing, with particular attention to generative models and machine learning tools. We review both benefits and limitations, highlight risks such as fabricated content, biased outputs, and erosion of accountability, and discuss why traditional detection approaches are insufficient. Instead, we argue for a shift toward transparency, provenance, and enforceable human responsibility as the core principles guiding AI use, ensuring that AI strengthens rather than undermines scientific rigour and public trust. We outline practical expectations for authors, reviewers, editors, and publishers, with emphasis on reporting standards, reproducibility under rapidly evolving model versions, and the conflict-of-interest implications of AI tooling for the editorial process itself.

AIMS:The Heart Failure Association (HFA) of the European Society of Cardiology (ESC), together with the National Heart Failure Societies (NHFS), designed the European Heart Failure (HF) Survey with an aim of assessing contemporary HF epidemiology, management resources, availability and reimbursement of guideline-directed medications and devices, and structure of professional and patient organizations. This document presents data on HF epidemiology. METHODS AND RESULTS:The European HF Survey was conducted in 43 ESC member countries. Epidemiology data were exclusively collected from national health statistics from 2019, and standardized according to the European Standard Population, with variable response rates and data completeness among the countries. Median annual HF incidence was 3.9 patients per 1000 person-years (interquartile range [IQR] 3.1-6.5), and median HF prevalence was 1937 patients (IQR 1463-3416) per 100 000 population. Median in-hospital mortality of patients admitted for HF was 8.0% (IQR 4.9-9.6%), and median 1-year all-cause mortality of patients with HF was 14.5% (IQR 8.2-21.6%). Median number of HF-related hospitalizations was 333 (IQR 230-469) per 100 000 population, and median length of stay for HF-related hospitalizations was 8.5 (IQR 7.2-9.2) days. A heterogeneity in HF epidemiology statistics was observed across different countries. CONCLUSIONS:The European HF Survey provides a contemporary insight into HF epidemiology and outcomes across the ESC member countries. These data are valuable to inform strategies to improve prevention, diagnosis, and management of HF. The persisting gaps and considerable heterogeneity in epidemiology statistics highlight the need to further unify data collection and reporting practices across European countries.

AIMS:The Heart Failure Frailty Score (HFFS) is a novel, multidimensional tool to assess frailty in patients with heart failure (HF). It has been developed to overcome limitations of existing frailty assessment tools while being practical for clinical use. The HFFS reflects the concept of frailty as a multidimensional, dynamic and potentially reversible state, which increases vulnerability to stressors and risk of poor outcomes in patients with HF. METHODS AND RESULTS:The HFFS was developed through a Delphi consensus process involving 54 international experts. This approach involved iterative rounds of questionnaires and interviews, where a panel of experts provided their opinions on specific questions prepared by the Steering Committee. The experts were invited to vote and share their views anonymously, using a 5-point Likert scale over iterative rounds. An 80% threshold was set for agreement or disagreement for each statement. Twenty-two variables from four domains (clinical, functional, psycho-cognitive and social) have been selected for inclusion in the HFFS after the third round of the Delphi process. A shorter version (S-HFFS), including 10 variables, has also been developed for daily clinical use. CONCLUSIONS:The HFFS is a new multidimensional tool for the identification of frailty in patients with HF. It should also enables healthcare providers to identify potential 'red flags' for frailty in order to develop personalized care plans. The next step will be to validate the new score in patients with HF.

Obesity and heart failure (HF) represent two growing pandemics. In the general population, obesity affects one in eight adults and is linked with an increased risk for HF. Obesity is even more common in patients with HF, where it complicates the diagnosis of HF and is linked with worse symptoms and impaired exercise capacity. Over the past few years, new evidence on the mechanisms linking obesity with HF has been reported, particularly in relation to HF with preserved ejection fraction. Novel therapies inducing weight loss appear to have favourable effects on health status and cardiovascular risk. Against the backdrop of this rapidly evolving evidence landscape, HF clinicians are increasingly required to tailor their preventive, diagnostic, and therapeutic approaches to HF in the presence of obesity. This scientific statement by the Heart Failure Association of the European Society of Cardiology provides an up-to-date summary on obesity in HF, covering key areas such as epidemiology, translational aspects, diagnostic challenges, therapeutic approaches, and trial design.

AIMS:The European Heart Failure (HF) Survey was developed by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) to map HF management resources, reimbursement of drugs/devices for HF treatment, and structure and activities of HF professional and patient organizations. METHODS AND RESULTS:The survey encompassed 43 ESC member countries. The median number of hospitals with dedicated HF centres was 2.6 (interquartile range [IQR] 0.9-4.7) per million people. Natriuretic peptide assessment was available at a median of 6.1 (IQR 1.8-10.6) emergency departments and 8.2 (IQR 1.3-14.7) hospitals per million people, respectively, whilst cardiac magnetic resonance was available at a median of 2.0 (IQR 0.9-3.8) hospitals per million people. Short-term and long-term mechanical circulatory support and heart transplantation were available at a median of 1.1 (IQR 0.5-2.4), 0.4 (IQR 0.0-0.5) and 0.3 (0.2-0.5) hospitals per million people, respectively. Whilst essential HF medications were mostly available and reimbursed, gaps were observed in availability and funding of newer and advanced therapies. Density of all diagnostic and therapeutic capabilities was greater in countries with more favourable socioeconomic status. National HF societies were reported in 98% of countries, whilst HF patient organizations in 45% of countries.anaemia. CONCLUSIONS:The European HF Survey is the result of long-standing HFA/ESC efforts to monitor HF epidemiology, management resources, educational and awareness activities. It offers a valuable assessment of current management capabilities, highlighting challenges in providing contemporary standards of care. It also provides insights into future directions needed to address these gaps.

BACKGROUND:The benefit of beta-blockers after myocardial infarction in patients with a preserved left ventricular ejection fraction (LVEF) is unclear. METHODS:We conducted a meta-analysis at the individual-patient level using data from five open-label trials that randomly assigned patients with recent myocardial infarction, no other indications for beta-blocker therapy, and an LVEF of at least 50% to receive beta-blocker therapy or no beta-blocker therapy. The primary end point was a composite of death from any cause, myocardial infarction, or heart failure. Event rates were analyzed with a one-stage fixed-effects Cox proportional-hazards model. RESULTS:A total of 17,801 patients were included from the REBOOT (7459 patients), REDUCE-AMI (4967 patients), BETAMI (2441 patients), DANBLOCK (2277 patients), and CAPITAL-RCT (657 patients) trials. Of these 17,801 patients, 8831 (49.6%) were assigned to receive a beta-blocker and 8970 (50.4%) were assigned to receive no beta-blocker. During a median follow-up of 3.6 years (interquartile range, 2.3 to 4.6), a primary-end-point event occurred in 717 patients (8.1%) in the beta-blocker group and 748 patients (8.3%) in the no-beta-blocker group (hazard ratio, 0.97; 95% confidence interval [CI], 0.87 to 1.07; P = 0.54). Death from any cause occurred in 335 patients in the beta-blocker group and 326 patients in the no-beta-blocker group (hazard ratio, 1.04; 95% CI, 0.89 to 1.21); myocardial infarction occurred in 360 and 407 patients, respectively (hazard ratio, 0.89; 95% CI, 0.77 to 1.03); and heart failure occurred in 75 and 87 patients (hazard ratio, 0.87; 95% CI, 0.64 to 1.19). CONCLUSIONS:In this meta-analysis including individual-patient data from five randomized trials, beta-blocker therapy did not reduce the incidence of death from any cause, myocardial infarction, or heart failure in patients with an LVEF of at least 50% after myocardial infarction without other indications for beta-blockers. (Funded by Centro Nacional de Investigaciones Cardiovasculares Carlos III and others; PROSPERO database number, CRD420251119176.).

Heart failure (HF) affects over 60 million individuals globally. Contemporary guideline-directed medical therapies (GDMT) reduce cardiovascular mortality and HF hospitalizations. However, medication non-adherence represents a critical barrier limiting real-world efficacy of GDMT. This scientific statement aims to provide a comprehensive framework for understanding, measuring, and addressing medication non-adherence in HF management across diverse healthcare settings. Addressing medication non-adherence requires systematic, multifaceted approaches targeting individual patient barriers while implementing system-level interventions. Polypills, digital monitoring platforms, enhanced patient education and empowerment, and multidisciplinary care models represent promising strategies to optimize therapeutic adherence and improve clinical outcomes in HF management.

focuses on risk prediction, both in a general context and within specific settings, aiming to enhance effective cardiovascular prevention in routine clinical practice.

Journal Article Corrected proof Cardiopulmonary limitations in young long COVID patients: a case control study Get access Geza Halasz, Geza Halasz Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology A.O. San Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152 Rome, Italy Corresponding author. Tel: +39 06 5870 4019, Email: geza.halasz@gmail.com https://orcid.org/0000-0001-7220-123X Search for other works by this author on: Oxford Academic Google Scholar Francesco Di Spigno, Francesco Di Spigno Cardiology Department, G. Da Saliceto Hospital, Via Taverna Giuseppe, 49, 29121 Piacenza Italy Search for other works by this author on: Oxford Academic Google Scholar Davide Donelli, Davide Donelli Department of Medicine and Surgery, University of Parma, Parma, Italy https://orcid.org/0000-0002-7895-2840 Search for other works by this author on: Oxford Academic Google Scholar Alessandro Giacani, Alessandro Giacani Department of Medicine and Surgery, University of Parma, Parma, Italy Search for other works by this author on: Oxford Academic Google Scholar Luca Moderato, Luca Moderato Cardiology Department, G. Da Saliceto Hospital, Via Taverna Giuseppe, 49, 29121 Piacenza Italy https://orcid.org/0000-0001-9652-1764 Search for other works by this author on: Oxford Academic Google Scholar Davide Lazzeroni, Davide Lazzeroni IRCSS Fondazione Don Carlo Gnocchi-ONLUS, via scandicci 269, 50143 Florence, Italy Search for other works by this author on: Oxford Academic Google Scholar Leonardo De Luca, Leonardo De Luca Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology A.O. San Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152 Rome, Italy Search for other works by this author on: Oxford Academic Google Scholar Massimo Piepoli Massimo Piepoli Clinical Cardiology Unit,IRCCS Policlinico San Donato, San Donato Milanese, Milan, ItalyDepartment of Biomedical Science for Health, University of Milan, Milan, Italy Search for other works by this author on: Oxford Academic Google Scholar European Journal of Preventive Cardiology, zwae029, https://doi.org/10.1093/eurjpc/zwae029 Published: 19 January 2024 Article history Received: 03 January 2024 Revision received: 11 January 2024 Accepted: 13 January 2024 Published: 19 January 2024 Corrected and typeset: 02 February 2024

PRKAG2 cardiomyopathy is a rare genetic disorder that manifests early in life with an autosomal dominant inheritance pattern. It harbors left ventricular hypertrophy (LVH), ventricular pre-excitation and progressively worsening conduction system defects. Its estimated prevalence among patients with LVH ranges from 0.23 to about 1%, but it is likely an underdiagnosed condition. We report the association of the PRKAG2 missense variant c.1006G>A p. (Val336Ile) with LVH, conduction abnormalities (short PR interval and incomplete right bundle branch bock) and early-onset arterial hypertension (AH) in a 44-year-old Caucasian patient. While cardiac magnetic resonance (CMR) showed a mild hypertrophic phenotype with maximal wall thickness of 17 mm in absence of tissue alterations, the electric phenotype was relevant including brady–tachy syndrome and recurrent syncope. The same variant has been detected in the patient’s sister and daughter, with LVH + early-onset AH and electrocardiographic (ECG) alterations + lipothymic episodes, respectively. Paying close attention to the coexistence of LVH and ECG alterations in the proband has been helpful in directing genetic tests to exclude primary cardiomyopathy. Hence, identifying the genetic basis in the patient allowed for familial screening as well as a proper follow-up and therapeutic management of the affected members. A review of the PRKAG2 cardiomyopathy literature is provided alongside the case report.

BackgroundA sex-based evaluation of prognosis in heart failure (HF) is lacking.Methods and resultsWe analyzed the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score registry, which includes HF with reduced ejection fraction (HFrEF) patients. A cross-validation procedure was performed to estimate weights separately for men and women of all MECKI score parameters: left ventricular ejection fraction (LVEF), hemoglobin, kidney function assessed by Modification of Diet in Renal Disease, blood sodium level, ventilation vs. carbon dioxide production slope, and peak oxygen consumption (peakVO2). The primary outcomes were the composite of all-cause mortality, urgent heart transplant, and implant of a left ventricle assist device. The difference in predictive ability between the native and sex recalibrated MECKI (S-MECKI) was calculated using a receiver operating characteristic (ROC) curve at 2 years and a calibration plot. We retrospectively analyzed 7,900 HFrEF patients included in the MECKI score registry (mean age 61 ± 13 years, 6,456 men/1,444 women, mean LVEF 33% ± 10%, mean peakVO2 56.2% ± 17.6% of predicted) with a median follow-up of 4.05 years (range 1.72–7.47). Our results revealed an unadjusted risk of events that was doubled in men compared to women (9.7 vs. 4.1) and a significant difference in weight between the sexes of most of the parameters included in the MECKI score. S-MECKI showed improved risk classification and accuracy (area under the ROC curve: 0.7893 vs. 0.7799, p = 0.02) due to prognostication improvement in the high-risk settings in both sexes (MECKI score >10 in men and >5 in women).ConclusionsS-MECKI, i.e., the recalibrated MECKI according to sex-specific differences, constitutes a further step in the prognostic assessment of patients with severe HFrEF.