1. Voors AA, Angermann CE, Teerlink JR, Collins SP, Kosiborod M, Biegus J, et al. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat Med 2022;28:568–574. https://doi.org/10.1038/s41591- 021-01659-1. The results suggest that the initiation of empagliflozin as part of usual care in patients who are hospitalized for acute heart failure will result in a clinically meaningful benefit in 90 days without safety concerns.
2. Solomon SD, McMurray JJV, Claggett B, de Boer RA, DeMets D, Hernandez AF, et al. Dapagliflozin in heart failure with mildly reduced and preserved ejection fraction. N Engl J Med 2022;387:1089–1098. https://doi.org/10.1056/NEJMoa2206286. Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure and a mildly reduced or preserved ejection fraction.
3. Jhund PS, Kondo T, Butt JH, Docherty KF, Claggett BL, Desai AS, et al. Dapagliflozin and outcomes across the range of ejection fraction in patients with heart failure: a pooled analysis of DAPA-HF and DELIVER. Nat Med 2022 (9):1956-1964. https://doi. org/10. 1038/s41591-022-01971-4. In a patient-level pooled meta-analysis covering the full range of ejection fractions in patients with heart failure, dapagliflozin reduced the risk of death from cardiovascular causes and hospital admissions for heart failure.
4. Ezekowitz JA, Colin-Ramirez E, Ross H, Escobedo J, Macdonald P, Troughton R, et al. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet 2022;399: 1391–1400. https://doi.org/10.1016/S0140-6736(22) 00369-5. In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events.
5. Butler J, Anker SD, Lund LH, Coats AJS, Filippatos G, Siddiqi TJ, et al. Patiromer for themanagement of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial. Eur Heart J 2022;43:4362–4373. https://doi.org/10.1093/eurheartj/ ehac401. Concurrent use of patiromer (a novel potassium-binder that exchanges potassium for calcium in the gastrointestinal tract) and high-dose mineralocorticoid receptor antagonists reduces the risk of recurrent hyperkalemia.
6. Mullens W, Dauw J, Martens P, Verbrugge FH, Nijst P, Meekers E, et al. Acetazolamide in acute decompensated heart failure with volume overload. N Engl J Med 2022;387: 1185–1195. https://doi.org/10.1056/NEJMoa2203094. The addition of acetazolamide to loop diuretic therapy in patients with acute decompensated heart failure resulted in a greater incidence of successful decongestion.
7. Trullàs JC, Morales-Rull JL, Casado J, Carrera- Izquierdo M, Sánchez-Marteles M, Conde- Martel A, et al. Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial. Eur Heart J 2023;44:411–421. The addition of hydrochlorothiazide to loop diuretic therapy improved diuretic response in patients with acute heart failure.
8. Perera D, Clayton T, O’Kane PD, Greenwood JP, Weerackody R, Ryan M, et al. Percutaneous revascularization for ischemic left ventricular dysfunction. N Engl J Med 2022;387:1351–1360. https://doi. org/10.1056/NEJMoa2206606. Among patients with severe ischemic left ventricular systolic dysfunction who received optimal medical therapy, revascularization by PCI did not result in a lower incidence of death from any cause or hospitalization for heart failure.
9. Shen L, Jhund PS, Docherty KF, Vaduganathan M, Petrie MC, Desai AS, et al. Accelerated and personalized therapy for heart failure with reduced ejection fraction. Eur Heart J 2022;43:2573–2587. https://doi. org/10.1093/eurheartj/ehac210. Modelling of accelerated up-titration schedule and optimized ordering of treatment suggested that at least 14 deaths and 47 patients experiencing the composite outcome per 1000 treated might be prevented over the first 12 months after starting therapy. Standard treatment guidance may not lead to the best patient outcomes in HFrEF, though these findings should be tested in clinical trials.
10. Mebazaa A, Davison B, Chioncel O, Cohen- Solal A, Diaz R, Filippatos G, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet 2022; 400:1938–1952. https://doi. org/10.1016/S0140-6736(22)02076-1. An intensive treatment strategy of rapid up-titration of guideline-directed medication and close follow-up after an acute heart failure admission was readily accepted by patients because it reduced symptoms, improved quality of life, and reduced the risk of 180-day all-cause death or heart failure readmission compared with usual care.
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