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Aims: Renin-angiotensin-aldosterone system inhibitors (RAASi) are guideline-recommended therapy for individuals with cardiorenal disease. They are associated with increased risk of hyperkalaemia, a common and life-threatening disorder for this population. RAASi-induced hyperkalaemia often leads to dose reduction or discontinuation, reducing cardiorenal protection. Guideline recommendations differ between specialties for the clinical management of hyperkalaemia. Using a modified Delphi method, we developed consensus recommendations for optimal management of hyperkalaemia in adults with cardiorenal disease.Methods and Results: An international steering group of cardiologists and nephrologists developed 39 statements regarding hyperkalaemia care, including risk factors and risk stratification, prevention, correction, and cross-specialty coordination. Consensus was determined by agreement on an online questionnaire administered to cardiorenal specialists across Europe and North America. The threshold for consensus agreement was established a priori by the steering group at 67%. Across November 2021, 520 responses were received from Canada (n = 50), France (n = 50), Germany (n = 54), Italy (n = 58), Spain (n = 57), the UK (n = 49), and the US (n = 202); 268 from cardiologists and 252 from nephrologists. Twenty-nine statements attained very high agreement (≥90%) and 10 attained high agreement (≥67%-<90%), with strong alignment between cardiologists and nephrologists.Conclusion: A high degree of consensus regarding hyperkalaemia evaluation and management exists among healthcare professionals. Based on high levels of agreement, the steering group derived six key recommendations for hyperkalaemia prevention and management in people with cardiorenal disease. Future studies examining the quality of hyperkalaemia care delivery are required. [ABSTRACT FROM AUTHOR]

Aims: Heart failure with reduced ejection fraction (HFrEF) remains associated with high morbidity and mortality, poor quality of life (QoL) and significant exercise limitation. Sympatho‐vagal imbalance has been shown to predict adverse prognosis and symptoms in HFrEF, yet it has not been specifically targeted by any guideline‐recommended device therapy to date. Barostim™, which directly addresses this imbalance, is the first Food and Drug Administration approved neuromodulation technology for HFrEF. We aimed to analyse all randomized trial evidence to evaluate the effect of baroreflex activation therapy (BAT) on heart failure symptoms, QoL and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in HFrEF. Methods and results: An individual patient data (IPD) meta‐analysis was performed on all eligible trials that randomized HFrEF patients to BAT + guideline‐directed medical therapy (GDMT) or GDMT alone (open label). Endpoints included 6‐month changes in 6‐min hall walk (6MHW) distance, Minnesota Living With Heart Failure (MLWHF) QoL score, NT‐proBNP, and New York Heart Association (NYHA) class in all patients and three subgroups. A total of 554 randomized patients were included. In all patients, BAT provided significant improvement in 6MHW distance of 49 m (95% confidence interval [CI] 33, 64), MLWHF QoL of −13 points (95% CI −17, −10), and 3.4 higher odds of improving at least one NYHA class (95% CI 2.3, 4.9) when comparing from baseline to 6 months. These improvements were similar, or better, in patients who had baseline NT‐proBNP <1600 pg/ml, regardless of the cardiac resynchronization therapy indication status. Conclusion: An IPD meta‐analysis suggests that BAT improves exercise capacity, NYHA class, and QoL in HFrEF patients receiving GDMT. These clinically meaningful improvements were consistent across the range of patients studies. BAT was also associated with an improvement in NT‐proBNP in subjects with a lower baseline NT‐proBNP. [ABSTRACT FROM AUTHOR]

Although the 2-year survival of the HVAD patients as compared to the HM3 patients in the matched cohorts of the EUROMACS registry did not reach statistical significance [HVAD 61% (95% confidence interval 56-67%) vs. In the past few decades, the treatment options for patients with advanced heart failure (HF) have changed dramatically.1 Since the introduction of (long-term) mechanical circulatory support (MCS), the prognosis and quality of life of these patients have improved significantly. Of note, in the INTERMACS registry, 30.5% of the HVAD patients and 42.6% of the HM3 patients of the original cohort were excluded for this analysis. [Extracted from the article]

European Society of Cardiology/Heart Failure Association position paper on the role and safety of new glucose-lowering drugs in patients with heart failure. The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. 23 Martin-Malo A, Borchard G, Flühmann B, Mori C, Silverberg D, Jankowska EA. Differences between intravenous iron products: focus on treatment of iron deficiency in chronic heart failure patients. Traditionally, the highest Altmetric scores have been reached with topics of social interest.4 On the other hand, in the field of heart failure (HF), a niche topic, fewer interactions are expected. [Extracted from the article]

He described HFA Atlas as an excellent example of cooperation between HFA and national HF societies, since the collection of the data was entirely based on voluntary contributions from NHFS/HF working groups. Volunteer participation at HFA Atlas and ESC/HFA HF registries was a highly commented upon topic, particularly recognition of participation in terms of authorship. There are 55 National Heart Failure Societies (NHFS) and Working Groups within the Heart Failure Association (HFA) providing important support to the HFA in the development of new ideas and programmes and in the promotion of heart failure (HF) as a target for both healthcare professionals and researchers. [Extracted from the article]

In this document, we propose a universal definition of heart failure (HF) as a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. We also propose revised stages of HF as: At risk for HF (Stage A), Pre‐HF (Stage B), Symptomatic HF (Stage C) and Advanced HF (Stage D). Finally, we propose a new and revised classification of HF according to left ventricular ejection fraction (LVEF). This includes HF with reduced ejection fraction (HFrEF): symptomatic HF with LVEF ≤40%; HF with mildly reduced ejection fraction (HFmrEF): symptomatic HF with LVEF 41–49%; HF with preserved ejection fraction (HFpEF): symptomatic HF with LVEF ≥50%; and HF with improved ejection fraction (HFimpEF): symptomatic HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF > 40%. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is causing considerable morbidity and mortality worldwide. Multiple reports have suggested that patients with heart failure (HF) are at a higher risk of severe disease and mortality with COVID-19. Moreover, evaluating and treating HF patients with comorbid COVID-19 represents a formidable clinical challenge as symptoms of both conditions may overlap and they may potentiate each other. Limited data exist regarding comprehensive management of HF patients with concomitant COVID-19. Since these issues pose serious new challenges for clinicians worldwide, HF specialists must develop a structured approach to the care of patients with COVID-19 and be included early in the care of these patients. Therefore, the Heart Failure Association of the European Society of Cardiology and the Chinese Heart Failure Association & National Heart Failure Committee conducted web-based meetings to discuss these unique clinical challenges and reach a consensus opinion to help providers worldwide deliver better patient care. The main objective of this position paper is to outline the management of HF patients with concomitant COVID-19 based on the available data and personal experiences of physicians from Asia, Europe and the United States. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and associated with considerable morbidity and mortality. Significant advances have recently occurred in the treatment of T2DM, with evidence of several new glucose-lowering medications showing either neutral or beneficial cardiovascular effects. However, some of these agents have safety characteristics with strong practical implications in HF [i.e. dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RA), and sodium-glucose co-transporter type 2 (SGLT-2) inhibitors]. Regarding safety of DPP-4 inhibitors, saxagliptin is not recommended in HF because of a greater risk of HF hospitalisation. There is no compelling evidence of excess HF risk with the other DPP-4 inhibitors. GLP-1 RAs have an overall neutral effect on HF outcomes. However, a signal of harm suggested in two small trials of liraglutide in patients with reduced ejection fraction indicates that their role remains to be defined in established HF. SGLT-2 inhibitors (empagliflozin, canagliflozin and dapagliflozin) have shown a consistent reduction in the risk of HF hospitalisation regardless of baseline cardiovascular risk or history of HF. Accordingly, SGLT-2 inhibitors could be recommended to prevent HF hospitalisation in patients with T2DM and established cardiovascular disease or with multiple risk factors. The recently completed trial with dapagliflozin has shown a significant reduction in cardiovascular mortality and HF events in patients with HF and reduced ejection fraction, with or without T2DM. Several ongoing trials will assess whether the results observed with dapagliflozin could be extended to other SGLT-2 inhibitors in the treatment of HF, with either preserved or reduced ejection fraction, regardless of the presence of T2DM. This position paper aims to summarise relevant clinical trial evidence concerning the role and safety of new glucose-lowering therapies in patients with HF. [ABSTRACT FROM AUTHOR]

Natriuretic peptides, brain (B‐type) natriuretic peptide (BNP) and N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP) are globally and most often used for the diagnosis of heart failure (HF). In addition, they can have an important complementary role in the risk stratification of its prognosis. Since the development of angiotensin receptor–neprilysin inhibitors (ARNIs), the use of natriuretic peptides as therapeutic agents has grown in importance. The present document is the result of the Trilateral Cooperation Project among the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America and the Japanese Heart Failure Society. It represents an expert consensus that aims to provide a comprehensive, up‐to‐date perspective on natriuretic peptides in the diagnosis and management of HF, with a focus on the following main issues: (1) history and basic research: discovery, production and cardiovascular protection; (2) diagnostic and prognostic biomarkers: acute HF, chronic HF, inclusion/endpoint in clinical trials, and natriuretic peptide‐guided therapy; (3) therapeutic use: nesiritide (BNP), carperitide (ANP) and ARNIs; and (4) gaps in knowledge and future directions. [ABSTRACT FROM AUTHOR]

Abstract: Central obesity is closely linked to hypertension and type-2 diabetes (DM2) in young/middle-age. In the elderly, systolic hypertension is a reflection of aging/stiff arteries. Diastolic (±systolic) hypertension in young/middle-age is accompanied by increased sympathetic nerve activity, particularly in the presence of the metabolic syndrome or DM2. High beta-receptor density (Bmax) and cyclic AMP (cAMP) levels in human lymphoctes, independent of blood pressure, are associated with a high risk of myocardial infarction (not stroke-risk, which is dependent on blood pressure). This has treatment implications in the young/middle-aged hypertensive subject. Antihypertensive agents that increase sympathetic nerve activity e.g. dihydropyridine calcium blockers, angiotensin receptor blockers, and thiazide-type diuretics, do not reduce (and may increase) the risk of myocardial infarction. Beta-1 blockade, effective in reversing and stabilising coronary atheromataous plaque, and with possible anti-tumor properties, is superior to ACE-inhibition, and is the treatment of choice in young/middle-aged hypertension with DM2. [Copyright &y& Elsevier]

Exergaming can be described as a computer game which requires rigorous physical exercise, and thus is ideally suited to elderly HF patients who may live alone and who find it difficult to attend formal group exercise sessions. B This article refers to 'Effects of exergaming on exercise capacity in patients with heart failure: results of an international multicentre randomized controlled trial' by T. Jaarsma I et al i ., published in this issue on pages 114-124. b In one of our Heart Failure News items in the Journal recently, I had the great pleasure to interview Tiny Jaarsma, full professor in nursing science at the Faculty of Medicine and Health Sciences of the University of Linköping (Sweden) and a professor in cardiovascular chronic care at the University Medical Center Utrecht (the Netherlands).1 Tiny is also coordinator of the "Patient care: management and delivery" Committee of the Heart Failure Association (HFA) and co-chair of the HFA Task Force on Palliative Care. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. [Extracted from the article]

Several trials have targeted neutral endopeptidase to demonstrate benefits for patients with heart failure. In the PARADIGM-HF trial, a combination of sacubitril and valsartan was superior to enalapril in reducing the risk of death and of hospitalization for heart failure. In this editorial we apply the trial to heart failure population at large to estimate what proportion of patients might actually be treated in daily practice. [ABSTRACT FROM AUTHOR]

Abstract: There have been many articles, reviews and editorials about the recent advances in pharmaceutical and device management of chronic heart failure in this and other journals over the last few years. What has been less praised are the significant advances we have made in understanding the best management of heart failure using other non-drug, non-surgical, non-device approaches. Approaches as diverse as nutrition, education, exercise, physiotherapy, psychotherapy and therapies for sleep-disordered breathing have shown considerable promise in improving the lot of our chronic heart failure (CHF) patients. Chronic heart failure is a common condition with a poor prognosis. It generates many debilitating symptoms for the sufferer. Non-pharmacologic treatment modalities play an important role alongside effective modern pharmaceutical, surgical and device therapies in relieving symptoms and improving prognosis. These treatments include those lifestyle measures that reduce the risk of underlying diseases such as coronary artery disease, diabetes, and hypertension lifestyle interventions of benefit in established CHF. Recent advances are reviewed including specialist nursing care, multi-disciplinary heart failure clinics, exercise rehabilitation, the treatment of sleep-disordered breathing, depression, obesity and cachexia. The day of the multi-disciplinary patient-centred CHF clinic has arrived and all sufferers deserve experienced management using all these approaches. [Copyright &y& Elsevier]

Anaemia has been found to be a common complication of chronic heart failure. It is associated with exercise intolerance and a poor prognosis, independent of conventional markers of heart failure severity and markers of renal dysfunction. Although the cause of anaemia complicating heart failure is not known, it is likely to be multi-factorial in many patients. Anaemia, when present, reduces oxygen delivery to the periphery. Correcting this may improve capacity. Erythropoietin therapy has a long history in the management of renal failure with complicating anaemia, and the first reports of the use of erythropoietin in heart failure are now coming through. This article will review what is known of the aetiology of anaemia in chronic heart failure and what may be possible for erythropoietic therapy to achieve in chronic heart failure. [Copyright &y& Elsevier]

Two trial programmes testing an anti-cytokine medication in chronic heart failure (CHF) have been halted. In the RENAISSANCE and RECOVER trials (the combined analysis being termed RENEWAL), 2048 CHF patients were randomised to placebo or one of 3 doses of etanercept, a fusion protein directed against TNF. Within RENAISSANCE and RECOVER a clinical composite score was used to assess the clinical effects at 24 weeks (primary endpoint: alpha 0.04). Overall, the number of patients who were classified to have during the trial “improved”, remained “unchanged” or “worsened” was similar for patients on placebo or any dose of etanercept (RENAISSANCE: p=0.17, RECOVER: p=0.34). In RENEWAL (combined analysis of medium and high dose etanercept vs. placebo), the primary endpoint (death or CHF hospitalisation, alpha 0.01) was not different between etanercept and placebo (RR 1.10, 95%CI 0.91 to 1.33, p=0.33). In RENEWAL, the secondary endpoint (death for any cause) was not different between etanercept and placebo (RR 1.13, 95%CI 0.86 to 1.50, p=0.39). ATTACH was a phase II, multicentre, randomised, double-blind, placebo-controlled pilot trial that aimed to evaluate the effects of infliximab (an antibody against TNF given in 2 different doses) in 150 CHF patients with stable NYHA class III or IV (in NYHA IV: <10%). In the placebo group (n=49), none of the patients died during 28 weeks of follow-up. At 14 (28) weeks, the endpoint of death or hospitalisation was reached in 2 (5) patients on placebo, in 2 (4) patients in the medium dose (5 mg/kg), and in 8 (13) patients in the high dose (10 mg/kg) of infliximab. During follow-up, compared to placebo the hazard to reach this endpoint was similar in the medium dose group (RR 0.80, 95%CI 0.22–2.99), but increased in the high dose group (RR 2.84, 95%CI 1.01–7.97, p<0.05). Conclusion: At the respective lower doses there was no safety issue with regards to the use of either infliximab or etanercept. High dose anti-TNF therapy may not be useful in CHF patients, but the situation in lower doses and in patients with documented inflammatory/metabolic problems or in cardiac cachexia has not yet been adequately assessed. [Copyright &y& Elsevier]

At the American College of Cardiology in March two major trials were presented. The publicity surrounding the two could not have been more different. The LIFE demonstrated clear superiority of losartan-based therapy over atenolol-based therapy for the treatment of hypertension. It was published the same week in the Lancet and received major press coverage all over the world.The OVERTURE (Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events) study in contrast received a subdued reception, very little publicity and is yet to be published. 5770 NYHA class II–IV heart failure patients (LVEF≤30%, recent heart failure hospital admission) were randomised and uptitrated to either 10 mg BD of Enalapril or 40 mg once a day Omapatrilat. The primary end-point of all cause mortality or heart failure related hospitalisation did not differ significantly: 914/2884 for Enalapril and 914/2886 for Omapatrilat (hazard ratio 0.94, CI’s 0.86–1.03, P=0.187) . Mortality was also similar: 509 for Enalapril and 477 for Omapatrilat (hazard ratio 0.94, CI’s 0.83–1.07, P=0.339). Omapatrilat was as good as Enalapril but not better. The worrying trend was however, that angioedema was more common with Omapatrilat; 24 (0.8%) versus 14 cases (0.5%).The OCTAVE (Omapatrilat Cardiovascular Treatment Assessment Versus Enalapril) study was also presented at this time. 25,267 hypertensives were randomised to Omapatrilat or enalapril and a difference of approximately 3 mmHg in favour of Omapatrilat was seen. Significantly more cases of angioedema were seen with Omapatrilat, 274 (2.17%) compared to 86 (0.68%) with enalapril. Overall death rates were similar, 0.18% for enalapril and 0.15% for Omapatrilat. All adverse events were similar, 51.0% for Omapatrilat and 50.4% for enalapril. The rates of angioedema were much higher in blacks, 5.54% for Ompatrilat and 1.62% for enalapril and for smokers, 3.93% for Omapatrilat and 0.81% for enalapril. We were left with a drug that was, for heart failure, not superior to an ACE inhibitor already off patent, and, as an anti-hypertensive, with an angioedema rate more than double that of an ACE inhibitor in a large head to head comparison. The medical community will be watching to make sure these data are published in full in the medical literature in a timely fashion, in the order of end-points specified in the protocol and with appropriate emphasis on the logical points of presentation. [ABSTRACT FROM AUTHOR]

Cachexia is a complication of many disorders. It is associated with an extremely poor prognosis and many symptoms. The wasting process affects particularly skeletal muscle causing extreme fatigue and weakness. In many underlying conditions associated with cachexia, the patient also suffers an often unexplained severe dyspnoea along with weakness, asthenia and exhaustion. There appears to be marked similarities in the cause of dyspnoea and fatigue between different cachectic conditions. Using the example of cardiac cachexia, this article reviews the evidence linking skeletal muscle reflex inputs to ventilatory control and exaggerated chemoreflex responses as candidates for the heightened perception of dyspnoea which cannot be explained by heart or lung dysfunction in many patients. Evidence is reviewed that similar processes may occur in other cachexias, especially those complicating cancer, AIDS, chronic liver disease, and chronic lung disease. Potential novel therapeutic strategies to combat these cachexia symptoms are reviewed. [Copyright &y& Elsevier]

The SGLT2i agents, dapagliflozin and empagliflozin, have recently demonstrated a consistent and significant prognostic benefit in patients with diabetes mellitus, and in patients with heart failure, with and without diabetes mellitus. As we are all too painfully aware, heart failure patients, especially those with reduced ejection fraction (HFrEF), have a very poor prognosis and a life expectancy that is markedly shorter than even those with severe chronic conditions, including cancer.1-4 Over the past decade new drug classes and devices have demonstrated a significant mortality and morbidity benefit in HFrEF. Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials. [Extracted from the article]

Guideline‐directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF) reduces morbidity and mortality, but its implementation is often poor in daily clinical practice. Barriers to implementation include clinical and organizational factors that might contribute to clinical inertia, i.e. avoidance/delay of recommended treatment initiation/optimization. The spectrum of strategies that might be applied to foster GDMT implementation is wide, and involves the organizational set‐up of heart failure care pathways, tailored drug initiation/optimization strategies increasing the chance of successful implementation, digital tools/telehealth interventions, educational activities and strategies targeting patient/physician awareness, and use of quality registries. This scientific statement by the Heart Failure Association of the ESC provides an overview of the current state of GDMT implementation in HFrEF, clinical and organizational barriers to implementation, and aims at suggesting a comprehensive framework on how to overcome clinical inertia and ultimately improve implementation of GDMT in HFrEF based on up‐to‐date evidence. [ABSTRACT FROM AUTHOR]

Focuses on the prevalence of fatigue among patients with chronic heart failure. Clinical significance of fatigue; Mechanisms of fatigue; Therapeutic strategies for reducing muscle fatigue.

Abstract: The medical literature is growing at an alarming rate. Research assessment exercises, research quality frameworks, league tables and the like have attempted to quantify the volume, quality and impact of research. Yet the established measures (such as citation rates) are being challenged by the sheer number of journals, variability in the “gold standard” of peer-review and the emergence of open-source or web-based journals. In the last few years, we have seen a growth in downloads to individual journal articles that now easily exceeds formal journal subscriptions. We have recorded the 10 top cited articles over a 12-month period and compared them to the 10 most popular articles being downloaded over the same time period. The citation-based listing included basic and applied, observational and interventional original research reports. For downloaded articles, which have shown a dramatic increase for the International Journal of Cardiology from 48,000 in 2002 to 120,000 in 2003 to 200,000 in 2004, the most popular articles over the same period are very different and are dominated by up-to-date reviews of either cutting-edge topics (such as the potential of stem cells) or of the management of rare or unusual conditions. There is no overlap between the two lists despite covering exactly the same 12-month period and using measures of peer esteem. Perhaps the time has come to look at the usage of articles rather than, or in addition to, their referencing. [Copyright &y& Elsevier]

Aims Methods and results Conclusions Recent guidelines recommend four core drug classes (renin–angiotensin system/angiotensin receptor–neprilysin inhibitor [RASi/ARNi], beta‐blocker, mineralocorticoid receptor antagonist [MRA], and sodium–glucose cotransporter 2 inhibitor [SGLT2i]) for the pharmacological management of heart failure (HF) with reduced ejection fraction (HFrEF). We assessed physicians' perceived (i) comfort with implementing the recent HFrEF guideline recommendations; (ii) status of guideline‐directed medical therapy (GDMT) implementation; (iii) use of different GDMT sequencing strategies; and (iv) barriers and strategies for achieving implementation.A 26‐question survey was disseminated via bulletin, e‐mail and social channels directed to physicians with an interest in HF. Of 432 respondents representing 91 countries, 36% were female, 52% were aged <50 years, and 90% mainly practiced in cardiology (30% HF). Overall comfort with implementing quadruple therapy was high (87%). Only 12% estimated that >90% of patients with HFrEF without contraindications received quadruple therapy. The time required to initiate quadruple therapy was estimated at 1–2 weeks by 34% of respondents, 1 month by 36%, 3 months by 24%, and ≥6 months by 6%. The average respondent favoured traditional drug sequencing strategies (RASi/ARNi with/followed by beta‐blocker, and then MRA with/followed by SGLT2i) over simultaneous initiation or SGLT2i‐first sequences. The most frequently perceived clinical barriers to implementation were hypotension (70%), creatinine increase (47%), hyperkalaemia (45%) and patient adherence (42%).Although comfort with implementing all four core drug classes in patients with HFrEF was high among physicians, a majority estimated implementation of GDMT in HFrEF to be low. We identified several important perceived clinical and non‐clinical barriers that can be targeted to improve implementation. [ABSTRACT FROM AUTHOR]

Discusses the increase, as of August 1998, in the prevalence of heart failure during the past 30 to 40 years. Statistics from hypolipidaemic and hypertensive trials; Risk factors identified from the Framingham study; Neurohormonal inhibition and the use of angiotensin-converting enzyme (ACE) inhibitors; Therapy for acute myocardial infarction; Strategies to prevent heart failure.

Aims: Many cancer patients die due to cardiovascular disease and sudden death, but data on ventricular arrhythmia prevalence and prognostic importance are not known. Methods and results: Between 2005 and 2010, we prospectively enrolled 120 unselected patients with lung, colon, or pancreatic cancer due to one of three diagnoses: colorectal (n = 33), pancreatic (n = 54), or non‐small cell lung cancer (n = 33). All were free of manifest cardiovascular disease. They were compared to 43 healthy controls similar in age and sex distribution. Each participant underwent 24 h electrocardiogram recording and cancer patients were followed for up to 12.5 years for survival (median 21 months). Ninety‐six cancer patients (80%) died during follow‐up [5‐year survival: 27% (95% confidence interval 19–35%)]. Non‐sustained ventricular tachycardia (NSVT) was more frequent in cancer patients vs. controls (8% vs. 0%, P = 0.021). The number of premature ventricular contractions (PVCs) over 24 h was not increased in cancer patients vs. controls (median 4 vs. 9, P = 0.2). In multivariable analysis, NSVT [hazard ratio (HR) 2.44, P = 0.047] and PVCs (per 100, HR 1.021, P = 0.047) were both significant predictors of mortality, independent of other univariable mortality predictors including tumour stage, cancer type, potassium concentration, prior surgery, prior cardiotoxic chemotherapy, and haemoglobin. In patients with colorectal and pancreatic cancer, ≥50 PVCs/24 h predicted mortality (HR 2.30, P = 0.0024), and was identified in 18% and 26% of patients, respectively. Conclusions: Non‐sustained ventricular tachycardia is more frequent in unselected patients with colorectal, pancreatic, and non‐small cell lung cancer and together with PVCs predict long‐term mortality. This raises the prospect of cardiovascular mortality being a target for future treatment interventions in selected cancers. [ABSTRACT FROM AUTHOR]

Aims: Heart failure outcomes remain poor despite advances in therapy. The European Society of Cardiology Heart Failure III Registry (ESC HF III Registry) aims to characterize HF clinical features and outcomes and to assess implementation of guideline‐recommended therapy in Europe and other ESC affiliated countries. Methods: Between 1 November 2018 and 31 December 2020, 10 162 patients with chronic or acute/worsening HF with reduced, mildly reduced, or preserved ejection fraction were enrolled from 220 centres in 41 European or ESC affiliated countries. The ESC HF III Registry collected data on baseline characteristics (hospital or clinic presentation), hospital course, diagnostic and therapeutic decisions in hospital and at the clinic visit; and on outcomes at 12‐month follow‐up. These data include demographics, medical history, physical examination, biomarkers and imaging, quality of life, treatments, and interventions – including drug doses and reasons for non‐use, and cause‐specific outcomes. Conclusion: The ESC HF III Registry will provide comprehensive and unique insight into contemporary HF characteristics, treatment implementation, and outcomes, and may impact implementation strategies, clinical discovery, trial design, and public policy. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a major disease in our society that often presents with multiple comorbidities with mutual interaction and aggravation. The comorbidity of HF and stroke is a high risk condition that requires particular attention to ensure early detection of complications, efficient diagnostic workup, close monitoring, and consequent treatment of the patient. The bi‐directional interaction between the heart and the brain is inherent in the pathophysiology of HF where HF may be causal for acute cerebral injury, and – in turn – acute cerebral injury may induce or aggravate HF via imbalanced neural and neurovegetative control of cardiovascular regulation. The present document represents the consensus view of the ESC Council on Stroke, the Heart Failure Association and the ESC Working Group on Thrombosis to summarize current insights on pathophysiological interactions of the heart and the brain in the comorbidity of HF and stroke. Principal aspects of diagnostic workup, pathophysiological mechanisms, complications, clinical management in acute conditions and in long‐term care of patients with the comorbidity are presented and state‐of‐the‐art clinical management and current evidence from clinical trials is discussed. Beside the physicians perspective, also the patients values and preferences are taken into account. Interdisciplinary cooperation of cardiologists, stroke specialists, other specialists and primary care physicians is pivotal to ensure optimal treatment in acute events and in continued long‐term treatment of these patients. Key consensus statements are presented in a concise overview on mechanistic insights, diagnostic workup, prevention and treatment to inform clinical acute and continued care of patients with the comorbidity of HF and stroke. [ABSTRACT FROM AUTHOR]

Aims: Despite strong evidence, access to exercise‐based cardiac rehabilitation (ExCR) remains low across global healthcare systems. We provide a contemporary update of the Cochrane review randomized trial evidence for ExCR for adults with heart failure (HF) and compare different delivery modes: centre‐based, home‐based (including digital support), and both (hybrid). Methods and results: Databases, bibliographies of previous systematic reviews and included trials, and trials registers were searched with no language restrictions. Randomized controlled trials, recruiting adults with HF, assigned to either ExCR or a no‐exercise control group, with follow‐up of ≥6 months were included. Two review authors independently screened titles for inclusion, extracted trial and patient characteristics, outcome data, and assessed risk of bias. Outcomes of mortality, hospitalization, and health‐related quality of life (HRQoL) were pooled across trials using meta‐analysis at short‐term (≤12 months) and long‐term follow‐up (>12 months) and stratified by delivery mode. Sixty trials (8728 participants) were included. In the short term, compared to control, ExCR did not impact all‐cause mortality (relative risk [RR] 0.93; 95% confidence interval [CI] 0.71–1.21), reduced all‐cause hospitalization (RR 0.69; 95% CI 0.56–0.86, number needed to treat: 13, 95% CI 9–22), and was associated with a clinically important improvement in HRQoL measured by the Minnesota Living with Heart Failure Questionnaire (MLWHF) overall score (mean difference: −7.39; 95% CI −10.30 to −4.47). Improvements in outcomes with ExCR was seen across centre, home (including digitally supported), and hybrid settings. A similar pattern of results was seen in the long term (mortality: RR 0.87, 95% CI 0.72–1.04; all‐cause hospitalization: RR 0.84, 95% CI 0.70–1.01, MLWHF: −9.59, 95% CI −17.48 to −1.50). Conclusions: To improve global suboptimal levels of uptake for HF patients, global healthcare systems need to routinely recommend ExCR and offer a choice of mode of delivery, dependent on an individual patient's level of risk and complexity. [ABSTRACT FROM AUTHOR]

Heart failure (HF) constitutes the growing cardiovascular burden and the major public health issue, but comprehensive statistics on HF epidemiology and related management in Europe are missing. The Heart Failure Association (HFA) Atlas has been initiated in 2016 in order to close this gap, representing the continuity directly rooted in the European Society of Cardiology (ESC) Atlas of Cardiology. The major aim of the HFA Atlas is to establish a contemporary dataset on HF epidemiology, resources and reimbursement policies for HF management, organization of the National Heart Failure Societies (NHFS) and their major activities, including education and HF awareness. These data are gathered in collaboration with the network of NHFS of the ESC member and ESC affiliated countries. The dataset will be continuously improved and advanced based on the experience and enhanced understanding of data collection in the forthcoming years. This will enable revealing trends, disparities and gaps in knowledge on epidemiology and management of HF. Such data are highly needed by the clinicians of different specialties (aside from cardiologists and cardiac surgeons), researchers, healthcare policy makers, as well as HF patients and their caregivers. It will also allow to map the snapshot of realities in HF care, as well as to provide insights for evidence-based health care policy in contemporary management of HF. Such data will support the ESC/HFA efforts to improve HF management ant outcomes through stronger recommendations and calls for action. This will likely influence the allocation of funds for the prevention, treatment, education and research in HF. [ABSTRACT FROM AUTHOR]

Background: Exercise training programmes (ETPs) are a crucial component in cardiac rehabilitation in heart failure (HF) patients. The Exercise Training in HF (ExTraHF) survey has reported poor implementation of ETPs in countries affiliated to the European Society of Cardiology (ESC). The aim of the present sub-analysis was to investigate the regional variations in the implementation of ETPs for HF patients.Methods and Results: The study was designed as a web-based survey of cardiac units, divided into five areas, according to the geographical location of the countries surveyed. Overall, 172 centres replied to the survey, in charge of 78 514 patients, differentiated in 52 Northern (n = 15 040), 48 Southern (n = 27 127), 34 Western (n = 11 769), 24 Eastern European (n = 12 748), and 14 extra-European centres (n = 11 830). Greater ETP implementation was observed in Western (76%) and Northern (63%) regions, whereas lower rates were seen in Southern (58%), Eastern European (50%) and extra-European (36%) regions. The leading barrier was the lack of resources in all (83-65%) but Western region (37%) where patients were enrolled in dedicated settings and specialized units (75%). In 40% of centres, non-inclusion of ETP in the national or local guideline pathway accounted for the lack of ETP implementation.Conclusion: Exercise training programmes are poorly implemented in the ESC affiliated countries, mainly because of the lack of resources and/or national and local guidelines. The linkage with dedicated cardiac rehabilitation centres (as in the Western region) or the model of local rehabilitation services adopted in Northern countries may be considered as options to overcome these gaps. [ABSTRACT FROM AUTHOR]