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Advances in the Diagnosis and Treatment of Heart Failure
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Advances in the Diagnosis and Treatment of Heart Failure

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 20 November 2025 | Viewed by 2575

Special Issue Editors

Dr. Noel Lorenzo-Villalba

E-Mail Website
Guest Editor
Hôpitaux Universitaires de Strasbourg, 1 avenue de Molière, 67000 Strasbourg, France
Interests: heart failure; hypertension; cardiology; coronary artery disease
Prof. Dr. Manuel Montero-Perez-Barquero

E-Mail Website
Guest Editor
Internal Medicine, IMIBIC, University Hospital "Reina Sofía", Córdoba, Spain
Interests: internal medicine; heart failure; blood pressure; hypertension; atrial fibrillation; diabetes

Special Issue Information

Dear Colleagues,

Heart failure (HF) is a highly prevalent clinical syndrome, affecting 65 million people worldwide, and its prevalence will continue to increase due to population aging and increased survival of the disease. In addition, this syndrome is associated with significant morbidity and mortality, loss of quality of life, and an increased number of hospital admissions, particularly in older adults. Diagnosis and management of heart failure remains a challenge, especially in elderly, pluripathological patients and patients with heart failure with preserved ejection fraction.

The aim of this Special Issue is collecting original research and comprehensive review articles covering topics related to diagnostics and treatments in heart failure. We are looking forward to receiving insightful submissions for this Special Issue.

Dr. Noel Lorenzo-Villalba
Prof. Dr. Manuel Montero-Perez-Barquero
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • heart failure
  • diagnosis
  • treatment
  • elderly
  • pluripathology

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Published Papers (3 papers)

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Research

10 pages, 1308 KiB  
Article
Is It Safe to Initiate/Optimize the Medication of HFrEF Patients During Hospitalization for Acute Decompensation?
by Ruxandra Maria Christodorescu, Daniel Miron Brie, Alina Diduța Brie, Cristian Mornoș, Simona Ruxandra Drăgan, Constantin Tudor Luca, Dan Dărăbanțiu and Alexandru Tîrziu
J. Clin. Med. 2025, 14(8), 2664; https://doi.org/10.3390/jcm14082664 - 13 Apr 2025
Viewed by 293
Abstract
Background: Current guidelines emphasize the importance of initiating or optimizing the four pillars of heart failure with reduced ejection fraction (HFrEF) therapy—beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), angiotensin receptor–neprilysin inhibitors (ARNI), and sodium–glucose cotransporter-2 inhibitors (SGLT2i)—during hospitalization for acute decompensation. This study compares [...] Read more.
Background: Current guidelines emphasize the importance of initiating or optimizing the four pillars of heart failure with reduced ejection fraction (HFrEF) therapy—beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), angiotensin receptor–neprilysin inhibitors (ARNI), and sodium–glucose cotransporter-2 inhibitors (SGLT2i)—during hospitalization for acute decompensation. This study compares clinical characteristics and outcomes in HFrEF patients hospitalized for decompensated heart failure based on whether they were newly initiated on or were already receiving at least one of these four pillars. Methods: This prospective observational study included 203 HFrEF patients hospitalized for acute decompensation. Patients were divided into two groups: Group A (n = 126), not receiving any of the four pillars prior to admission, and Group B (n = 77), receiving at least one. Clinical and biological parameters were evaluated during hospitalization, with outcomes including changes in weight, blood pressure, heart rate, renal function (serum creatinine), electrolyte levels (sodium, potassium), and 30-day mortality. Statistical analyses included the non-parametric Mann–Whitney test and Chi-squared test. Results: Baseline characteristics (age, gender, LVEF, NT-proBNP) were similar between the two groups. No significant difference was observed in 30-day mortality (Group A: 7.14%, Group B: 5.55%, p = 0.74). Both groups experienced significant improvements in systolic and diastolic blood pressure and heart rate during hospitalization (p < 0.05). While serum creatinine levels remained stable in both groups, creatinine dynamics (Δcreatinine) were significantly different (p = 0.02), with Group B exhibiting a higher increase. The improvement in ejection fraction was more pronounced in Group A (p = 0.057) compared to Group B. Both groups demonstrated significant improvements in NYHA functional class (p < 0.001). In Group B, the use of MRAs and SGLT2 inhibitors significantly increased during hospitalization (p = 0.01 and p < 0.001, respectively). Conclusions: The initiation or optimization of the four pillars of HFrEF therapy during hospitalization for acute decompensation is feasible and well-tolerated. Early intervention leads to improvements in clinical parameters and functional status, supporting guideline recommendations for in-hospital initiation or optimization of HFrEF therapy. Special consideration should be given to renal function when optimizing therapy. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Heart Failure)
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13 pages, 693 KiB  
Article
Medical Costs and Economic Impact of Hyperkalemia in a Cohort of Heart Failure Patients with Reduced Ejection Fraction
by Andrea López-López, Margarita Regueiro-Abel, Emilio Paredes-Galán, Charigan Abou Johk-Casas, José María Vieitez-Flórez, Juliana Elices-Teja, Jorge Armesto-Rivas, Raúl Franco-Gutiérrez, Ramón Ríos-Vázquez and Carlos González-Juanatey
J. Clin. Med. 2025, 14(1), 58; https://doi.org/10.3390/jcm14010058 - 26 Dec 2024
Viewed by 767
Abstract
Background/Objectives: Hyperkalemia is a common electrolyte disorder in patients with heart failure and reduced ejection fraction (HFrEF). Renin-angiotensin-aldosterone system inhibitors (RAASi) have been shown to improve survival and decrease hospitalization rates, although they may increase the serum potassium levels. Hyperkalemia has significant [...] Read more.
Background/Objectives: Hyperkalemia is a common electrolyte disorder in patients with heart failure and reduced ejection fraction (HFrEF). Renin-angiotensin-aldosterone system inhibitors (RAASi) have been shown to improve survival and decrease hospitalization rates, although they may increase the serum potassium levels. Hyperkalemia has significant clinical and economic implications, and is associated with increased healthcare resource utilization. The objective of the study was to analyze the management of hyperkalemia and the associated medical costs in a cohort of patients with HFrEF. Methods: An observational, longitudinal, retrospective, single-center retrospective study was conducted in patients with HFrEF who started follow-up in a heart failure unit between 2010 and 2021. Results: The study population consisted of 1181 patients followed-up on for 64.6 ± 38.8 months. During follow-up, 11,059 control visits were conducted, documenting 438 episodes of hyperkalemia in 262 patients (22.2%). Of the hyperkalemia episodes, 3.0% required assistance in the Emergency Department, 1.4% required hospitalization, and only 0.2% required admission to the Intensive Care Unit. No episode required renal replacement therapy. Reduction or withdrawal of RAASi was necessary in 69.9% of the hyperkalemia episodes. The total cost of the 438 hyperkalemia episodes was €89,178.82; the expense during the first year accounted for 48.8% of the total cost. Conclusions: Hyperkalemia is frequent in patients with HFrEF. It is often accompanied by a modification of treatment with RAASi. Hyperkalemia generates substantial costs in terms of healthcare resources and medical care, especially during the first year. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Heart Failure)
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16 pages, 1799 KiB  
Article
Low Muscle Strength Assessed with Dynamometry in Elderly Polypathological Patients with Acute Heart Failure: PROFUND-IC Registry
by Alicia Guzmán-Carreras, Jorge San Miguel-Agudo, Mateo Paz-Cabezas, Máximo Bernabeu-Wittel, Nuria Muñoz-Rivas, Beatriz Sánchez-Sauce, Fernando Aguilar-Rodríguez, Luis Cabeza-Osorio, Emmanuel Andrès, Noel Lorenzo-Villalba and Manuel Méndez-Bailón
J. Clin. Med. 2024, 13(16), 4873; https://doi.org/10.3390/jcm13164873 - 18 Aug 2024
Cited by 1 | Viewed by 1141
Abstract
Background: Sarcopenia is a comorbidity associated with heart failure, which aggravates its prognosis. Objectives: To analyze the differential characteristics of polypathological patients with acute heart failure (AHF) based on the presence of low muscle strength, as well as to study whether this condition [...] Read more.
Background: Sarcopenia is a comorbidity associated with heart failure, which aggravates its prognosis. Objectives: To analyze the differential characteristics of polypathological patients with acute heart failure (AHF) based on the presence of low muscle strength, as well as to study whether this condition is associated with a worse prognosis. Methods: An observational study of 377 patients with a diagnosis of acute heart failure from the prospective multicentric PROFUND-IC registry was carried out. The main variable is low muscle strength, which is assessed with dynamometry or prehensile strength. Epidemiological and anthropometric characteristics, as well as associated comorbidities, were analyzed. Likewise, the etiology of the AHF episode, the number of admissions in the previous year, and the NYHA scale were also included. Finally, scores on functionality, treatment established, and mortality and readmission rates were studied. Quantitative variables are described as mean, and standard deviation, and qualitative variables are expressed as absolute numbers and percentages. A descriptive and bivariate analysis was performed according to the presence of low muscle strength (handgrip <27 kg in men and <16 kg in women), using the Welch test for quantitative measures and Chi-square for qualitative variables. In addition, Kaplan-Meier curves of readmission and mortality and a logistic regression analysis were also performed. Results: 377 patients were included (56% female, mean age 83 years). 310 (82.23%) had low muscle strength. Those with low muscle strength were older (84 vs. 78 years, p < 0.001), with more cognitive impairment (11.9% vs. 0%, p = 0.021), worse functional class (p = 0.016), lower scores in the Barthel index and Rockwood scale (p < 0.001), and higher in the PROFUND index (p < 0.001). They had higher rates of readmission and mortality without statistically significant differences. The PROFUND index is significantly associated with low muscle strength (OR 1.19, CI (1.09–1.31), p < 0.001). Conclusions: Elderly polypathological patients with acute heart failure and low muscle strength have a higher PROFUND index and a lower probability of survival per year. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Heart Failure)
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