1. Brugts JJ, Radhoe SP, Clephas PRD, Aydin D, van Gent MWF, Szymanski MK, et al. Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial. Lancet 2023;401: 2113–23.
Haemodynamic monitoring substantially improved quality of life and reduced heart failure hospitalisations in patients with moderate-to-severe heart failure treated according to contemporary guidelines. These findings contribute to the aggregate evidence for this technology and might have implications for guideline recommendations and implementation of remote pulmonary artery pressure monitoring.
2. Mentz RJ, Anstrom KJ, Eisenstein EL, Sapp S, Greene SJ, Morgan S, et al. Effect of torsemide vs furosemide after discharge on all-cause mortality in patients hospitalized with heart failure: the TRANSFORM-HF randomized clinical trial. JAMA 2023;329:214–23.
Among patients discharged after hospitalization for heart failure, torsemide compared with furosemide did not result in a significant difference in all-cause mortality over 12 months. However, interpretation of these findings is limited by loss to follow-up and participant crossover and nonadherence.
3. Yeoh S E, Osmanska J, Petrie MC, Brooksbank KJM, Clark AL, Docherty KF, et al. Dapagliflozin versus metolazone in heart failure resistant to loop diuretics. Eur Heart J 2023;44:2966–77.
In patients with heart failure and loop diuretic resistance, dapagliflozin was not more effective at relieving congestion than metolazone. Patients assigned to dapagliflozin received a larger cumulative dose of furosemide but experienced less biochemical upset than those assigned to metolazone.
4. Maaten JM T, Beldhuis IE, van der Meer P, Krikken JA, Postmus D, Coster JE, et al. Natriuresis-guided diuretic therapy in acute heart failure: a pragmatic randomized trial. Nat Med 2023;29:2625–32.
The PUSH-AHF trial is the first randomized clinical trial to show that natriuresis-guided diuretic therapy improves natriuresis and diuresis in patients with acute heart failure. An important observation from the PUSHAHF trial is that natriuresis-guided diuretic therapy was safe and did not result in more (serious) adverse events or prespecified renal events. The PUSH-AHF study provides a first step towards a personalized natriuresisguided approach in patients with acute heart failure.
5. Adamo M, Pagnesi M, Mebazaa A, Davison B, Edwards C, Tomasoni D, et al. NT-proBNP and high-intensity care for acute heart failure: the STRONGHF trial. Eur Heart J 2023;44:2947–62.
Among patients with acute heart failure enrolled in STRONG-HF, high-intensity care reduced 180-day HF readmission or death regardless of baseline NT-proBNP. Guideline-recommended medical therapy up-titration early post-discharge, utilizing increased NT-proBNP as guidance to increase diuretic therapy and reduce the Guideline-recommended medical therapy up-titration rate, resulted in the same 180- day outcomes regardless of early postdischarge NT-proBNP change.
6. Sorajja P, Whisenant B, Hamid N, Naik H, MakkarR, TadrosP, etal. Transcatheterrepair for patients with tricuspid regurgitation. N Engl J Med 2023;388:1833–42.
Tricuspid Transcatheter edge-to-edge repair was safe for patients with severe tricuspid regurgitation, reduced the severity of tricuspid regurgitation, and was associated with an improvement in quality of life.
7. Lee DS, Straus SE, Farkouh ME, Austin PC, Taljaard M, Chong A, et al. Trial of an intervention to improve acute heart failure outcomes. N Engl J Med 2023;388:22–32.
Among patients with acute heart failure who were seeking emergency care, the use of a hospital-based strategy to support clinical decision making and rapid follow-up led to a lower risk of the composite of death from any cause or hospitalization for cardiovascular causes within 30 days than usual care.
8. Mentz RJ, Garg J, Rockhold FW, Butler J, De Pasquale CG, Ezekowitz JA, et al. Ferric carboxymaltose in heart failure with iron deficiency. N Engl J Med 2023;389:975–86.
Among ambulatory patients who had heart failure with a reduced ejection fraction and iron deficiency, there was no apparent difference between ferric carboxymaltose and placebo with respect to the hierarchical composite of death, hospitalizations for heart failure, or 6-minute walk distance.
9. Kosiborod MN, Abildstrøm SZ, Borlaug BA, Butler J, Rasmussen S, Davies M, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med 2023;389:1069–84.
In patients with heart failure with preserved ejection fraction and obesity, treatment with semaglutide (2.4 mg) led to larger reductions in symptoms and physical limitations, greater improvements in exercise function, and greater weight loss than placebo.
10. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2023;44:3627–39.
The 2023 focused guideline update of the ESC for the diagnosis and treatment of heart failure includes an expansion of the class I recommendation for the use of SGLT2i in patients with HFpEF and heart failure with mildly reduced EF (HFmrEF). Thus, this medication class is unique, as it should be given to all HF patients for improvement of prognosis independently of left ventricular EF. The rapid initiation and titration of the four Guidelines recommended medical treatment drugs are now recommended (IB) after a heart failure decompensation. Patients with HFrEF or HFmrEF and iron deficiency should be treated (IIaA) with intravenous administration of iron carboxymaltose or iron derisomaltose. For patients with both type 2 diabetes mellitus and chronic kidney disease, the update also recommends SGLT2i to reduce heart failure hospitalization or cardiovascular death (IA) as well as the non-steroidal mineralocorticoid receptor antagonist finerenone to reduce heart failure hospitalizations (IA).
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