Multidisciplinary specialists in coronary heart failure care from throughout the UK and wider afield gathered for the latest twenty sixth British Society of Coronary heart Failure (BSH) annual assembly. This 12 months’s programme sought to spotlight how collaboration, coordination and cooperation would finally be important for the supply and success of the flagship 25in25 initiative. The assembly, held on the Queen Elizabeth II Centre, London, on thirtieth November and 1st December 2023, supplied thought-provoking plenary classes, targeted masterclasses, a brand new ‘expertise in motion’ demonstration space, plus quite a few high-quality poster shows. Dr Aaron Henry reviews highlights from the assembly.
25in25
The assembly started with an replace on the 25in25 initiative from BSH Chair-Elect Dr Lisa Anderson (St George’s College Hospital, London). This nationwide high quality enchancment initiative, led by the BSH in collaboration with over 54 nationwide and worldwide healthcare organisations, has the objective of lowering coronary heart failure deaths by 25% over the subsequent 25 years. With already over a million folks within the UK dwelling with coronary heart failure, a quantity which is predicted to double by 2040, the bold initiative is eagerly awaited. Within the UK alone this might translate to over 10,000 lives saved per 12 months.
A inhabitants well being strategy underpins the initiative, with an emphasis on nationwide collaboration. The preliminary steps contain the implementation of fast-track communities (FTC), impressed by the HIV quick monitor cities mannequin.1 This strategy consists of the creation of a dashboard to evaluate metrics throughout 4 key areas:
Identification of these susceptible to coronary heart failure
Correct and well timed prognosis
Guideline directed-medical remedy
High quality of life and wellbeing
Desk 1. British Society for Coronary heart Failure ‘25in25’ quick monitor communities
Swansea
Blackpool
North West Anglia
Birmingham
Liverpool
Jersey
Glasgow
Seven websites have been introduced for the initiation of the FTC challenge (see desk 1), which began in January 2024. The plan is to roll out the challenge nationally in 2025, with important engagement from EU governments and worldwide societies promising additional growth internationally.
Cardiometabolic clinics
Dr Mimi Chen (St George’s College Hospital, London), a Advisor Endocrinologist, shared experiences of creating a profitable cardiometabolic clinic at St George’s. The importance of this clinic stems from the alarming international prevalence of diabetes – affecting one in 11 adults, and anticipated to rise to over 600 million by 2045.2 These sufferers are at a two- to three-fold elevated threat of coronary heart illness. Equally, the prevalence of weight problems, a recognised contributor to coronary heart failure, is rising with nearly two-thirds of UK adults chubby or overweight.3
This clinic adopts a multidisciplinary strategy, integrating the experience of a coronary heart failure heart specialist, an endocrinologist, and a coronary heart failure pharmacist. Its major operate is to handle heart problems (CVD) in sufferers who’re dwelling with diabetes or weight problems. The clinic accepts referrals from inside belief specialists, encompassing cardiology, metabolic, and surgical departments, in addition to from group coronary heart failure groups. Collaboration with different specialisms is a key function of the clinic, involving sleep clinics, hepatology, bariatric surgical procedure, group coronary heart failure and lymphoedema groups. A big focus is positioned on the American Coronary heart Affiliation’s (AHA) ‘Life’s Easy 7’4 prescription for cardiovascular well being:
Give up smoking
Eat higher
Get lively
Drop some weight
Handle blood stress
Management ldl cholesterol
Cut back blood sugar
The clinic additionally emphasises the significance of early initiation of triple remedy for these with heart problems and ‘diabesity’—a mix of metformin, a sodium-glucose co-transport-2 (SGLT2) inhibitor, and a glucagon-like peptide 1(GLP-1) receptor agonist. There are, in fact, challenges, together with sick day guidelines, remedy side-effect profiles, insulin adjustment, remedy discontinuation, and the nationwide scarcity of GLP-1 receptor agonists. The clinic’s strategy provides a number of benefits: it leverages a number of areas of experience, reduces ready instances for cross-referral (shortening this era by a minimum of six months), and promotes early intervention and admission avoidance. Trying ahead, the clinic goals to broaden its multidisciplinary group by together with a nephrologist to evolve right into a CardioRenalMetabolic clinic, enhancing its scope and efficacy in treating advanced sufferers.
Weight problems and coronary heart failure
Professor Naveed Sattar (College of Glasgow) defined why coronary heart failure specialists ought to find out about weight problems. It’s strongly linked to coronary heart failure. This is because of each will increase in threat components, reminiscent of hypertension, diabetes and dyslipidaemia but in addition a direct impact, which is way more durable to measure and certain consists of haemodynamic, mobile components over vitamin and inflammatory mechanisms. Furthermore, knowledge from registries and genetic research implicate weight problems in having a causal position within the growth of coronary heart failure.5,6
It follows that treating weight problems will cut back the probability of creating coronary heart failure, and non-randomised research of bariatric surgical procedure have proven important reductions in coronary heart failure incidence following weight reduction surgical procedure.7 Newer research have shone a light-weight on concentrating on weight problems in these dwelling with coronary heart failure. The STEP HFpEF (Semaglutide in Sufferers with Coronary heart Failure with Preserved Ejection Fraction and Weight problems) trial, offered finally 12 months’s European Society of Cardiology (ESC) Congress, confirmed that the GLP-1 receptor agonist semaglutide was related to each a 13% lower in physique weight and a exceptional enchancment in high quality of life.8 Placing this enchancment in signs into context, the outcomes have been considerably higher than these seen in trials investigating SGLT2 inhibitors or mineralocorticoid receptor antagonists (MRAs) for coronary heart failure with preserved ejection fraction (HFpEF).9 Consequence trials of weight reduction therapies in coronary heart failure at the moment are eagerly awaited, particularly with a suggestion of decrease coronary heart failure hospitalisations from the lately revealed SELECT (Semaglutide and Cardiovascular Outcomes in Weight problems with out Diabetes) trial.10 Excitingly, new weight reduction therapies are in growth together with a mixed triple agonist (GLP-1, gastric inhibitory peptide [GIP] and glucagon), retatrutide, attaining weight reduction just like that seen in bariatric surgical procedure.11
Philip Poole-Wilson Memorial Lecture
The 2023 Memorial Lecture was given by Professor John McMurray (College of Glasgow), who highlighted the numerous developments in coronary heart failure therapy and understanding which have taken place over the previous 15 years for the reason that passing of Professor Poole-Wilson, the founding chair of the BSH.
He started by reflecting on the 2008 coronary heart failure tips, the place ACE inhibitors and beta blockers have been the cornerstone remedies. He mentioned the position of MRAs, citing RALES (Randomised Aldactone Analysis Examine),12 and the event of sacubitril/valsartan, emphasising its impression as revealed within the PARADIGM-HF (International Mortality and Morbidity in Coronary heart Failure) examine.13 In fact, a latest spotlight has been the event of SGLT2 inhibitors which have proven profit in coronary heart failure no matter ejection fraction as evidenced in DAPA-HF (Dapagliflozin and Prevention of Adversarial Outcomes in Coronary heart Failure),14 DELIVER (Dapagliflozin Analysis to Enhance the Lives of Sufferers With Preserved Ejection Fraction Coronary heart Failure),15 EMPEROR-Diminished (Empagliflozin Consequence Trial in Sufferers with Power Coronary heart Failure and a Diminished Ejection Fraction),16 and EMPEROR-Preserved (Empagliflozin Consequence Trial in Sufferers with Power Coronary heart Failure with Preserved Ejection Fraction)17 trials.
Professor McMurray additionally outlined three elementary shifts within the new 2023 replace to the 2021 ESC tips for coronary heart failure administration:18
The urgency of early therapy initiation, underscoring the significance of immediate motion.
The primacy of initiation of therapy over typical dose titration, emphasising the significance of beginning all 4 pillars of remedy.
The flexibleness within the order and sequence of remedy administration, permitting for tailor-made affected person care.
He additionally touched upon the event of chemically-engineered medicine like omecamtiv mecarbil19 and the continuing efforts to grasp the position of intravenous iron in coronary heart failure, referencing the IRONMAN (Intravenous Ferric Derisomaltose in Sufferers with Coronary heart Failure and Iron Deficiency within the UK)20 and HEART-FID (Ferric Carboxymaltose in Coronary heart Failure with Iron Deficiency)21 research. He additionally mentioned the more and more recognised significance of managing arrhythmias in coronary heart failure, notably atrial fibrillation, citing the CASTLE HF (Catheter Ablation for Atrial Fibrillation with Coronary heart Failure)22 trial and the upcoming CRAAFT-HF and CABA-HFpEF research.
Concluding his lecture, Professor McMurray mentioned the exploration of recent therapies in coronary heart failure. This included extra selective MRAs (FINEARTS-HF trial), the investigation into the position of irritation in coronary heart failure (HERMES trial), and the impression of weight problems on coronary heart failure, as highlighted within the STEP HFpEF and SUMMIT trials.
Natriuretic peptides
At this 12 months’s assembly, the concentrate on natriuretic peptides (NPs) included discussions led by Professor Antonio Bayes-Genis (College Hospital Germans Trias i Pujol de Badalona, Barcelona, Spain) and Dr Clare Taylor (College of Oxford). Professor Bayes-Genis launched the ‘Peptide for Life’ initiative,23 which goals to standardise NP testing entry in major care and emergency departments throughout Europe. Endorsed by the ESC, this initiative emerged from the Coronary heart Failure Affiliation Atlas, highlighting the numerous use of NPs in several areas. Its objective is to boost early detection and administration of coronary heart failure by constant and widespread use of NP testing.
Dr Taylor examined the usage of NPs in UK major care. She famous that coronary heart failure sufferers recognized locally have higher survival charges than these recognized in hospitals, emphasising the significance of NP testing. Regardless of a 17-fold improve in NP testing from 2004 to 2018, the prognosis charge has remained at about 10%, with the median NP stage at prognosis (round 1200 pg/ml for NT-proBNP) suggesting late-stage detection.24
She additionally addressed the talk on NP thresholds, evaluating the Nationwide Institute for Well being and Care Excellence (NICE) (<400 pg/ml NT-proBNP) and ESC (<125 pg/ml NT-proBNP) tips. Giant GP datasets indicated a sensitivity of 82% at >400 pg/ml, lacking roughly one in 5 coronary heart failure circumstances, versus 95% sensitivity at >125 pg/ml.25 Decreasing the brink, nonetheless, raises considerations about overburdening cardiology companies.
Dr Taylor additionally offered knowledge linking NP ranges at prognosis to hospitalisation and mortality dangers. Alarmingly, over 50% of sufferers have been hospitalised inside a 12 months of prognosis, with a median delay of 101 days between testing and prognosis.26 Excessive NT-proBNP ranges (>2000 pg/ml) doubled the danger of hospitalisation and elevated coronary heart failure mortality by 50% at one, 5, and 10 years, highlighting the necessity for immediate prognosis and intervention.
Early Investigator Award
Three glorious candidates offered their work within the Early Investigator Award session. Dr Fardad Soltani (College of Manchester) offered work in phenogrouping HFpEF utilizing digital healthcare data and machine studying. Utilising the Nationwide Institute for Well being and Care Analysis (NIHR) Well being Informatics Cardiovascular database from 5 hospital trusts, Dr Soltani analysed knowledge from 2000 sufferers with left ventricular ejection fraction (LVEF) >40%. This led to the identification of three distinct phenogroups (desk 2). Notably, the third group was discovered to have a threefold threat of loss of life, underscoring the potential of machine studying in enhancing our understanding of HFpEF.
Desk 2. Early Investigator Award
Investigator
Location
Title
Take away message
Fardad Soltani
Manchester
Phenogrouping HFpEF utilizing digital well being file knowledge
Three phenogrpups recognized
Youthful, feminine, cardiometabolic threat components
Male, frail, AF
Diabetes, renal dysfunction and excessive CRP
Ramesh Nadarajah
Leeds
Prediction of incident HF in community-based digital well being data: systematic assessment, meta-analysis and UK prediction mannequin growth and validation
There are a lot of fashions which predict five- and 10-year threat of HF however they’ve restricted efficiency in predicting short- time period HF. This mannequin is scalable and precisely predicts each short- and long-term HF.
Daniel Hammersley
London
Myocardial tissue remodelling in DCM in medical remission
Remission of DCM phenotype was related to regression of interstitial fibrosis and discount of subclinical myocardial irritation, however this might not be predicted.
Key: AF = atrial fibrillation; CRP = C-reactive protein; DCM = dilated cardiomyopathy; HF = coronary heart failure; HFpEF = coronary heart failure with preserved ejection fraction
Dr Ramesh Nadarajah (College of Leeds) targeted on predicting coronary heart failure in community-based well being data by a scientific assessment and meta-analysis of 59 prediction fashions. Though these fashions excelled in long-term (5 and 10 12 months) predictions, their efficiency in short-term (inside one 12 months) prognosis was variable and unsure. Dr Nadarajah then labored on creating a novel choice help software with excessive accuracy in each short- and long-term prediction, utilizing a half-million affected person derivation cohort and a virtually 100,000 affected person validation cohort.
Lastly, Dr Daniel Hammersley (Nationwide Coronary heart and Lung Institute, London) explored myocardial tissue remodelling in dilated cardiomyopathy (DCM). The REMIT-DCM (Reverse Remodelling Markers Within the Serial Analysis of Latest-onset Dilated Cardiomyopathy) examine, involving baseline, two to 3 months, and 12-month follow-ups with cardiac MRI and blood checks, discovered that 31% of sufferers skilled DCM remission. Curiously, no baseline medical or MRI parameters might predict 12-month remission. The examine revealed that regression of myocardial fibrosis and discount in subclinical myocardial irritation have been widespread in those that improved, suggesting these as potential therapeutic targets. It was additionally famous that substitute fibrosis doesn’t preclude DCM remission.
Congratulations to all three early profession investigators and particularly to the winner Dr Nadarajah.
BSH Analysis Fellows
We additionally loved an replace from present BSH Analysis Fellows on their progress. Janine Beezer (South Tyneside and Sunderland Basis Belief), Jo Bilak (College of Leicester), Elton Luo (Citadel Hill Hospital, Hull) and Matthew Sadler (King’s School Hospital, London) all offered updates on their research (desk 3). Dr Simon Beggs (College of Glasgow), previous BSH Analysis Fellow, additionally offered proof on the RHYTHM-HF examine. This examine sought to tell on how arrhythmias contribute to loss of life or rehospitalisation in coronary heart failure sufferers. Sufferers have been recruited throughout index hospitalisation for coronary heart failure and acquired an injectable cardiac monitor. Dr Begg confirmed that in these with an adjudicated pump failure loss of life, the reason for loss of life could also be as a consequence of an unidentified various pathology, reminiscent of a myocardial infarction or pulmonary embolus, though this can’t be extrapolated from the terminal rhythm. Dr Begg additionally confirmed that adjudicated sudden cardiac deaths could also be as a consequence of unidentified pathology together with non-cardiac pathology, and these could also be related to a secondary ventricular arrhythmia. Once more, the underlying reason for loss of life couldn’t be extrapolated from the terminal rhythm.
Desk 3. BSH Analysis Fellows
BSH Analysis Fellow
Mission
Janine Beezer
Polypharmacy in coronary heart failure: investigating the connection between therapy and outcomes – the POTION examine
Jo Bilak
A Multi-Ethnic, multi-centre randomised, managed trial of a low-energy eating regimen for bettering purposeful standing in coronary heart failure with preserved ejection fraction – the AMEND-Preserved examine
Elton Luo
Examine utilizing two giant major care networks to establish sufferers on loop diuretics who will not be on the guts failure registry
Matthew Sadler
Position of clonal haematopoiesis (CHIP) in ventricular remodelling after myocardial infarction
Coronary heart failure medical trials replace
An replace on coronary heart failure medical trials (desk 4) was given by Professor John Cleland (College of Glasgow). He additionally made the case for following the lead of our oncology colleagues, who goal to have 20% of their sufferers enrolled in medical trials. This is able to equate to round 200,000 coronary heart failure sufferers within the UK enrolled in a medical trial.
Desk 4. Replace on coronary heart failure medical trials
Trials
Abstract
Just lately Accomplished
IRONMAN20
IV iron appeared to decrease the danger of HF hospitalisation in sufferers with HFrEF and iron deficiency
REVIVED27
PCI didn’t enhance outcomes in sufferers with extreme ischaemic left ventricular systolic dysfunction
Recruiting
HFpEF Registry28
Redefining HFpEF into extra distinct phenogroups utilizing multiomics
REACH-HFpEF29
Investigating a home-based cardiac rehabilitation programme in HFpEF
SUBCUT-HF II
Subcutaneous furosemide to allow early supported discharge in HF
PROTECT-HF
Assessing ventricular pacing by proper ventricle pacing vs conduction system pacing in sufferers with an LVEF >35%
BRITISH30
Effectiveness of an ICD/CRT-D in sufferers with non-ischaemic cardiomyopathy (LVEF <35%) and scar current on CMR
Funded
CONTEMP-ICD
ICD vs medical remedy alone in sufferers with HFrEF and LVEF <35% who’ve a decrease threat of arrhythmic than non-arrhythmic loss of life
CRAAFT-HF
AF ablation in sufferers with HFrEF and HFmrEF
CORAL
Assessing medical and price effectiveness of co-enzyme Q10 in sufferers with HFrEF
SOPHIST
Sotagliflozin for HF and kind 1 diabetes, assessing high quality of life and security
CROSS-HF
Invasive or non-invasive imaging for coronary illness in sufferers with new HF
STITCH3-BCIS431
PCI or CABG in sufferers with ischaemic LV dysfunction and multivessel illness
Pilots
IDEAL-HF
Delaying ICD remedy in HFrEF sufferers medically optimised with an LVEF <35% till echo reassessment at 12 months
THINK-HF
Feasibility trial of digital well being file ‘clever tooling’ in major take care of faster prognosis of HF
Key: CABG = coronary artery bypass graft; CMR = cardiac magnetic resonance; CRT-D = cardiac resynchronisation remedy – defibrillator; HF = coronary heart failure; HFmrEF = coronary heart failure with mildy decreased ejection fraction; HFpEF = coronary heart failure with preserved ejection fraction; HFrEF = coronary heart failure with decreased ejection fraction; ICD = implantable cardioverter defibrillator; IV = intravenous; LVEF = left ventricular ejection fraction; PCI = percutaneous coronary intervention
Acute coronary heart failure – diuretics
Professor Andrew Clark (College of Hull) delivered an entertaining and insightful lecture on diuretic administration in acute coronary heart failure. He summarised trials performed in acute coronary heart failure and the proof generated from these trials (desk 5). Regardless of many many years of diuresing sufferers, there may be nonetheless not a consensus on how diuretics needs to be used and what the objective of therapy needs to be. What is evident, nonetheless, is that congestion is a unfavourable prognostic marker, and the extra congestion you’ve gotten the more serious your consequence is more likely to be. Professor Clark concluded by saying: “Sufferers hardly ever fail to reply to diuretics, however we generally fail to prescribe sufficient diuretics”.
Desk 5. Trials of diuretic remedy
Trial
Particulars
Abstract
DOSE32
AHF receiving both bolus (12 hourly) or infusion of both excessive (2.5 x residence dose) or low (residence) dose furosemide
No statistical distinction in signs or kidney operate throughout teams, however development in the direction of improved signs in excessive dose group
CARESS-HF33
AHF with cardiorenal syndrome, randomised to stepped pharmacological remedy or ultrafiltration
Ultrafiltration is related to extra opposed occasions, worsening renal operate and no change in weight in comparison with medical remedy
CLOROTIC-HCTZ34
Addition of HCTZ to IV furosemide in sufferers with AHF
The addition of HCTZ to loop diuretic remedy improved diuretic response, worsened renal operate with out inflicting important hyponatraemia or hypokalaemia
ADVOR35
Acetazolamide along with loop diuretics in AHF
The addition of acetazolamide for 3 days improves the proportion who achieved decongestion
3T36
Comparability of metolazone versus chlorothiazide versus tolvaptan along with furosemide in AHF
Good weight reduction throughout teams with no important distinction between teams
PUSH-HF37
Does natriuresis-guided diuretic remedy enhance outcomes in AHF
Measuring urinary sodium, with elevated diuretic depth if <70mmol/L, improved natriuresis and diuresis
Key: AHF = acute coronary heart failure; HCTZ = hydrochlorothiazide; IV = intravenous
Ejection fraction – time to maneuver on?
Within the penultimate session of the assembly, consideration turned to ejection fraction (EF) as a measure of left ventricular operate. Dr Sarah Hudson (Wye Valley NHS Belief) opened the session with a historical past of EF, from its first use by Folse and Braunwald in 1962 to the primary cardiac magnetic resonance (CMR) scan in 1985. Professor Chris Miller (College of Manchester) then mentioned how imaging strategies reminiscent of CMR and computed tomography (CT) can present a wealth of information past EF to additional perceive aetiology, prognosis and assist therapy. Dr Joe Cuthbert (College of Hull) nonetheless outlined how latest medical trial proof helps the usage of EF to information therapy, and due to this fact we would want an excellent cause to maneuver on from its use. It could be much less essential at sure instances, reminiscent of acute presentation with congestion and finish of life. Lastly, Dr Fozia Ahmed (Manchester College NHS Basis Belief) raised the essential situation of sex-specific variations in cardiac construction and performance, the place females are likely to have a better regular EF (e.g. >60%). That is essential as rising proof suggests girls could profit from neurohormonal blockade as much as a better EF. Additional analysis is required to analyze these sex-specific variations.
BSH diary dates
twenty ninth February 2024: Deadline for BSH Fellowship 2024–25 functions
twenty fifth–twenty sixth April 2024: BSH MDT assembly, Glasgow
twenty first–twenty second November 2024: twenty seventh Annual Assembly of the BSH, London
Conflicts of Curiosity
None declared.
J. Aaron HenryCardiology Fellow, Jersey Basic HospitalVisiting Researcher, College of Oxford[email protected]
References
1. Duncombe C, Ravishankar S, Zuniga JM. Quick-Observe Cities: striving to finish city HIV epidemics by 2030. Curr Opin HIV AIDS 2019;14:503–8. https://doi.org/10.1097/coh.0000000000000583
2. Zheng Y, Ley SH, Hu FB. International aetiology and epidemiology of kind 2 diabetes mellitus and its issues. Nat Rev Endocrinol 2018;14:88–98. https://doi.org/10.1038/nrendo.2017.151
3. Digital N. Well being Survey for England. 2021. https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2021
4. AHA. Life’s Easy 7. American Coronary heart Affiliation. 2020. https://playbook.coronary heart.org/lifes-simple-7/
5. Robertson J, Lindgren M, Schaufelberger M, et al. Physique mass index in younger girls and threat of cardiomyopathy: a long-term follow-up examine in Sweden. Circulation 2020;141:520–9. https://doi.org/10.1161/circulationaha.119.044056
6. Larsson SC, Bäck M, Rees JMB, Mason AM, Burgess S. Physique mass index and physique composition in relation to 14 cardiovascular situations in UK Biobank: a Mendelian randomization examine. Eur Jeart J 2019;41:221–6. https://doi.org/10.1093/eurheartj/ehz388
7. Liakopoulos V, Franzén S, Svensson A-M, Sattar N, et al. Renal and cardiovascular outcomes after weight reduction from gastric bypass surgical procedure in kind 2 diabetes: cardiorenal threat reductions exceed atherosclerotic advantages. Diabetes Care 2020;43:1276–84. https://doi.org/10.2337/dc19-1703
8. Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in sufferers with coronary heart failure with preserved ejection fraction and weight problems. N Eng J Med 2023;389:1069–84. https://doi.org/10.1056/NEJMoa2306963
9. Verma S, Borlaug BA, Butler J, et al. An enormous STEP for therapy of coronary heart failure with preserved ejection fraction. Cell Metab 2023;35:1681–7. https://doi.org/10.1016/j.cmet.2023.08.003
10. Lincoff AM, Brown-Frandsen Okay, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in weight problems with out diabetes. N Engl J Med 2023;389:2221–32. https://doi.org/10.1056/NEJMoa2307563
11. Jastreboff AM, Kaplan LM, Frías JP, et al. Triple–hormone-receptor agonist retatrutide for weight problems — a part 2 trial. N Engl J Med 2023;389:514–26. https://doi.org/10.1056/NEJMoa2301972
12. Pitt B, Zannad F, Remme WJ, et al. The impact of spironolactone on morbidity and Mmortality in sufferers with extreme coronary heart failure. N Engl J Med 1999;341:709–17. https://doi.org/10.1056/nejm199909023411001
13. McMurray JJV, Packer M, Desai AS, et al. Angiotensin–neprilysin inhibition versus enalapril in coronary heart failure. N Engl J Med 2014;371:993–1004. https://doi.org/10.1056/NEJMoa1409077
14. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in sufferers with coronary heart failure and decreased ejection fraction. N Engl J Med 2019;381:1995–2008. https://doi.org/10.1056/NEJMoa1911303
15. Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in coronary heart failure with mildly decreased or preserved ejection fraction. N Engl J Med 2022;387:1089–98. https://doi.org/10.1056/NEJMoa2206286
16. Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in coronary heart failure. N Engl J Med 2020;383:1413–24. https://doi.org/10.1056/NEJMoa2022190
17. Anker SD, Butler J, Filippatos G, et al. Empagliflozin in coronary heart failure with a preserved ejection fraction. N Engl J Med 2021;385:1451–61. https://doi.org/10.1056/NEJMoa2107038
18. McDonagh TA, Metra M, Adamo M, et al. 2023 Targeted Replace of the 2021 ESC Tips for the prognosis and therapy of acute and persistent coronary heart failure. Eur Coronary heart J 2023;44:3627–39. https://doi.org/10.1093/eurheartj/ehad195
19. Teerlink JR, Diaz R, Felker GM, et al. Cardiac myosin activation with omecamtiv mecarbil in systolic coronary heart failure. N Engl J Med 2021;384:105–16. https://doi.org/10.1056/NEJMoa2025797
20. Kalra PR, Cleland JGF, Petrie MC, et al. Intravenous ferric derisomaltose in sufferers with coronary heart failure and iron deficiency within the UK (IRONMAN): an investigator-initiated, potential, randomised, open-label, blinded-endpoint trial. Lancet 2022;400:2199–209. https://doi.org/10.1016/s0140-6736(22)02083-9
21. Mentz RJ, Garg J, Rockhold FW, et al. Ferric carboxymaltose in coronary heart failure with iron deficiency. N Engl J Med 2023;389:975–86. https://doi.org/10.1056/NEJMoa2304968
22. Sohns C, Fox H, Marrouche NF, et al. Catheter ablation in end-stage coronary heart failure with atrial fibrillation. N Engl J Med 2023;389:1380–9. https://doi.org/10.1056/NEJMoa2306037
23. Bayes-Genis A, Januzzi JL, Richards AM, et al. The ‘Peptide for Life’ Initiative: a name for motion to supply equal entry to the usage of natriuretic peptides within the prognosis of acute coronary heart failure throughout Europe. Eur J Coronary heart Fail 2021;23:1432–6. https://doi.org/10.1002/ejhf.2293
24. Roalfe AK, Lay-Flurrie SL, Ordóñez-Mena JM, et al. Long run tendencies in natriuretic peptide testing for coronary heart failure in UK major care: a cohort examine. Eur Coronary heart J 2021;43:881–91. https://doi.org/10.1093/eurheartj/ehab781
25. Taylor CJ, Ordóñez-Mena JM, Lay-Flurrie SL, et al. Natriuretic peptide testing and coronary heart failure prognosis in major care: diagnostic accuracy examine. Br J Gen Prac 2023;73:e1–e8. https://doi.org/10.3399/bjgp.2022.0278
26. Taylor CJ, Lay-Flurrie SL, Ordóñez-Mena JM, et al. Natriuretic peptide stage at coronary heart failure prognosis and threat of hospitalisation and loss of life in England 2004–2018. Coronary heart 2022;108:543–9. https://doi.org/10.1136/heartjnl-2021-319196
27. Perera D, Clayton T, O’Kane PD, et al. Percutaneous revascularzation for ischemic left ventricular dysfunction. N Engl J Med 2022;387:1351–60. https://doi.org/10.1056/nejmoa2206606
28. Group UHC. Rationale and design of the UK Coronary heart Failure with Preserved Ejection Fraction Registry. Coronary heart 2023:heartjnl-2023-323049. https://doi.org/10.1136/heartjnl-2023-323049
29. Lang CC, Smith Okay, Wingham J, et al. A randomised managed trial of a facilitated home-based rehabilitation intervention in sufferers with coronary heart failure with preserved ejection fraction and their caregivers: the REACH-HFpEF Pilot Examine. BMJ Open 2018;8:e019649. https://doi.org/10.1136/bmjopen-2017-019649
30. Flett A, Cebula A, Nicholas Z, Adam R, et al. Rationale and examine protocol for the BRITISH randomized trial (Utilizing cardiovascular magnetic resonance recognized scar because the benchmark threat indication software for implantable cardioverter defibrillators in sufferers with nonischemic cardiomyopathy and extreme systolic coronary heart failure). Am Coronary heart J 2023;266:149–58. https://doi.org/10.1016/j.ahj.2023.09.008
31. Fremes SE, Marquis-Gravel G, Gaudino MFL, et al. STICH3C: Rationale and examine protocol. Circ Cardiovasc Interv 2023;16:e012527. https://doi.org/10.1161/circinterventions.122.012527
32. Felker GM, Lee KL, Bull DA, et al. Diuretic methods in sufferers with acute decompensated coronary heart failure. N Engl J Med 2011;364:797–805. https://doi.org/10.1056/NEJMoa1005419
33. Bart BA, Goldsmith SR, Lee KL, et al. Ultrafiltration in decompensated coronary heart failure with cardiorenal syndrome. N Engl J Med 2012;367:2296–2304. https://doi.org/10.1056/NEJMoa1210357
34. Trullàs JC, Morales-Rull JL, Casado J, et al. Combining loop with thiazide diuretics for decompensated coronary heart failure: the CLOROTIC trial. Eur Coronary heart J 2023;44:411–21. https://doi.org/10.1093/eurheartj/ehac689
35. Mullens W, Dauw J, Martens P, et al. Acetazolamide in acute decompensated coronary heart failure with quantity overload. N Engl J Med 2022;387:1185–95. https://doi.org/10.1056/nejmoa2203094
36. Cox ZL, Hung R, Lenihan DJ, Testani JM. Diuretic methods for loop diuretic resistance in acute coronary heart failure. JACC: Coronary heart Fail 2020;8:157–68. https://doi.org/10.1016/j.jchf.2019.09.012
37. ter Maaten JM, Beldhuis IE, van der Meer P, et al. Natriuresis-guided diuretic remedy in acute coronary heart failure: a practical randomized trial. Nature Med 2023;29:2625–32. https://doi.org/10.1038/s41591-023-02532-z