Linking guideline-directed medical therapy (GDMT) implementation and appropriate polypharmacy management in heart failure (HF). Polypharmacy can represent a barrier to the proper implementation of life-prolonging GDMT for HF. A reasonable balance between the optimization of GDMT and avoiding inappropriate polypharmacy is mandatory in the contemporary care of patients with HF. Clinicians are encouraged to use individualized risk–benefit assessments, and patient-centred goals should be defined and pursued, which include outcomes such as prognosis and quality of life (QoL), or factors more related with treatments such as adherence, tolerance and safety. There are multiple aspects that can contribute to the success of the overall process: collaboration with other healthcare professionals and structured interdisciplinary interventions, implementation of digital technologies, use, when appropriate, of fixed-dose combinations for simplification of medication regimens. Life-prolonging medications should be regularly prioritized during the processes of medication revision and appropriateness of non-HF treatment medications critically reassessed. Targeting polypharmacy through a stepwise approach can contribute to facilitate GDMT implementation strategies, to preserve adherence and, finally, to better GDMT.

Efficacy and safety of finerenone in patients with chronic kidney disease and type 2 diabetes by diuretic use: a FIDELITY analysis. CI, confidence interval; CKD, chronic kidney disease; CV, cardiovascular; eGFR, estimated glomerular filtration rate; FIDELIO-DKD, FInerenone in reducing kiDnEy faiLure and dIsease prOgression in Diabetic Kidney Disease; FIDELITY, FInerenone in chronic kiDney diseasE and type 2 diabetes: Combined FIDELIO-DKD and FIGARO-DKD Trial programme analYsis; FIGARO-DKD, FInerenone in reducinG cArdiovascular moRtality and mOrbidity in Diabetic Kidney Disease; HHF, hospitalization for heart failure; HR, hazard ratio; K⁺, potassium; MI, myocardial infarction; T2D, type 2 diabetes; TEAE, treatment-emergent adverse event. ^aIf patients were receiving both types of diuretics at baseline, they were included in both subgroups. Patients receiving diuretics who were not included in either group were taking non-loop, non-thiazide diuretics. ^bComposite of time to CV death, non-fatal MI, non-fatal stroke, or HHF. ^cCV composite outcome component(s). ^dComposite of time to kidney failure, sustained ≥57% decrease in eGFR from baseline over ≥4 weeks, or kidney-related death.

Effects of sacubitril/valsartan with or without background beta-blocker therapy in patients with heart failure with reduced ejection fraction from PARADIGM-HF. BB, beta-blocker; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CRT, cardiac resynchronization therapy; HF, heart failure; HR, hazard ratio; ICD, implantable cardioverter-defibrillator; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid receptor antagonist; NT-proBNP, N-terminal pro-B-type natriuretic peptide; NYHA, New York Heart Association; RR, rate ratio.

Sex differences in the PARADISE-MI echocardiographic substudy.

HeartMate 3 time-varying analyses. LVAD, left ventricular assist device.

Predictors of weaning failure from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock. RRT, renal replacement therapy.

Schematic representation of the study workflow, pathological model, experimental workflow, and key findings deriving from the integration of clinical trials, public databases, and the cellular model. SGLT2-i, sodium–glucose cotransporter 2 inhibitor; T2D, type 2 diabetes.

Association of ventricular–arterial coupling with heart failure (HF) biomarkers in the STANISLAS cohort. MMP, matrix metalloproteinase; NT-proBNP, N-terminal pro-B-type natriuretic peptide.

Changes in serum phosphate levels over time with ferric carboxymaltose (FCM) in a randomized, double-blind, prospective substudy of HEART-FID assessing the following outcomes: serum phosphate, 1,25 dihydroxyvitamin D, 25-hydroxyvitamin D levels and plasma levels of intact parathyroid hormone during 6 months subsequent to FCM infusion. The study included a total of 133 patients (n = 62 FCM, n = 71 placebo). Outcomes are shown for each substudy visit at baseline through day 14, 21, 35, 63, 91, 119, and 160. NT-proBNP, N-terminal pro-B-type natriuretic peptide.

Association of iron markers with congestion, functional capacity and prognosis. Congestion assessment at rest by ultrasound: B-lines ≥4, discontinuous renal venous flow and dilated inferior vena cava (≥21 mm). Functional capacity by peak oxygen uptake (VO₂): ≥16 ml/kg/min, 10–15.9 ml/kg/min and <10 ml/kg/min. Adjusted analyses (Cox proportional hazard ratios) illustrate a higher risk of heart failure hospitalization (HFH) and all-cause mortality (ACM) after a median follow-up of 18 months in patients with heart failure and iron deficiency (ID) as assessed by transferrin saturation (TSAT) <20% and iron ≤13 μmol/L. All models were adjusted for age (years), sex (male), diabetes, haemoglobin (Hb, g/dl), estimated glomerular filtration rate (ml/min/1.73 m²), Ln(NT-proBNP) (pg/ml), Ln (hs-CRP) (mg/dl), atrial fibrillation/flutter, peak VO₂ <16 ml/kg/min and heart failure phenotype (heart failure with preserved vs. reduced ejection fraction), including its interaction with iron markers. CI, confidence interval; hs-CRP, high-sensitivity C-reactive protein; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro-B-type natriuretic peptide; US, ultrasound.

The International Registry of MitraClip in Acute Mitral Regurgitation following Acute Myocardial Infarction (IREMMI). CI, confidence interval; OR, odds ratio; TEER, transcatheter edge-to-edge repair.