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Clinical Challenges in Heart Failure Management
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Clinical Challenges in Heart Failure Management

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

Deadline for manuscript submissions: 25 August 2025 | Viewed by 2634

Special Issue Editors

Dr. Paolo Severino

E-Mail Website
Guest Editor
Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy
Interests: heart failure; ischemic heart disease; chronic heart failure; myocardial infarction; clinical cardiology; acute heart failure
Dr. Gaetano M. Ruocco

E-Mail
Guest Editor
Cardiology Unit, "Buon Consiglio Hospital" Fatebenefratelli, Naples, Italy
Interests: acute heart failure; heart failure; clinical cardiology; myocardial infarction; chronic heart failure; echocardiography; cardiac function; cardiovascular medicine; cardiac imaging; internal medicine

Special Issue Information

Dear Colleagues,

Heart failure (HF) is a pandemic of the third millennium, accounting for high rates of mortality and hospitalizations. The HF burden has exposed cardiologists and hospitals to an increasing number of patients requiring treatments. For this reason, an improved approach to HF is required. The introduction of new treatments strategies, such as guanylate cyclase stimulators and myosin activators, is opening up new possibilities for HF patients to avoid adverse events. Moreover, the results of recent SGLT2i trials have opened up new treatment possibilities for HF patients with preserved ejection fraction. Besides pharmacological treatment, interesting results have been observed regarding cardiac contractility modulation (CCM) in patients with refractory symptoms, reducing the number of HF and CV deaths.  Moreover, the COVID era showed the potential of telemedicine in HF, opening the possibility of managing HF patients with virtual visits beyond classical in-person visits. In conclusion, the correct stratification of HF patients, distinguishing who needs advanced treatment strategies from those requiring palliative care, is needed in order to improve the quality of life of patients.

This Special Issue will focus on new challenges in heart failure management. Original articles, reviews of the current literature, and original perspectives on this topic will be taken into account. The Special Issue will focus on diagnostic, prognostic, and therapeutic innovations with the aim of sharing clinical experiences to improve HF patients’ management.

Dr. Paolo Severino
Dr. Gaetano M. Ruocco
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

  • acute heart failure
  • chronic heart failure
  • inotropic support
  • left ventricular assist device
  • cardiac contractility modulation
  • guanylate cyclase stimulators
  • quality of life
  • telemedicine
  • palliative care

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Published Papers (3 papers)

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Research

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9 pages, 582 KiB  
Article
Usefulness of Myocardial Injury Parameters in Predicting Prolonged Postoperative Use of Inotropes Drugs in Patients Undergoing Heart Valve Surgery
by Piotr Duchnowski, Witold Śmigielski and Piotr Kołsut
J. Clin. Med. 2025, 14(8), 2719; https://doi.org/10.3390/jcm14082719 - 15 Apr 2025
Viewed by 125
Abstract
Background: Prolonged use of inotropes drugs in the early postoperative period is one of the most common complications occurring in patients undergoing heart valve surgery. Patients requiring prolonged support via inotropes drugs are significantly more likely to experience serious postoperative complications such as [...] Read more.
Background: Prolonged use of inotropes drugs in the early postoperative period is one of the most common complications occurring in patients undergoing heart valve surgery. Patients requiring prolonged support via inotropes drugs are significantly more likely to experience serious postoperative complications such as acute kidney injury, cardiogenic shock, multiple organ dysfunction syndrome, and death. This study assessed the usefulness of selected perioperative parameters in predicting prolonged postoperative use of inotropic drugs and cardiogenic shock and/or death in a group of patients requiring prolonged supply of inotropes drugs. Methods: This prospective study was conducted on a group of 607 patients undergoing heart valve surgery. The primary endpoint in-hospital follow-up was prolonged postoperative use of inotropes drugs. The secondary composite endpoint was cardiogenic shock requiring mechanical circulatory support (MCS) and/or death from any cause in patients with prolonged postoperative use of inotropes drugs. Results: A total of 210 patients required inotropes drugs for more than 48 h. Age (p = 0.03), preoperative atrial fibrillation (p < 0.001), preoperative NT-proBNP level (p < 0.001), Troponin T measured one day after surgery (TnT II) (p < 0.001), and the need for urgent postoperative rethoracotomy (p < 0.001) remained independent predictors of primary endpoint. Preoperative hemoglobin level (p = 0.001) and TnT II (p < 0.001) were independent predictors of death and cardiogenic shock requiring MCS. Conclusions: Patients with elevated preoperative NT-proBNP values, as well as with increasing postoperative troponin T levels, are at risk of prolonged postoperative use of inotropes drugs, a complication which is associated with a significant risk of developing further adverse consequences, such as cardiogenic shock and death. Full article
(This article belongs to the Special Issue Clinical Challenges in Heart Failure Management)
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13 pages, 1324 KiB  
Article
A Tri-Component (Glomerular, Tubular, and Metabolic) Assessment of Renal Function in Acute Heart Failure
by Gracjan Iwanek, Barbara Ponikowska, Husam Salah, Marat Fudim, Mateusz Guzik, Robert Zymliński, Krzysztof Aleksandrowicz, Beata Ponikowska and Jan Biegus
J. Clin. Med. 2024, 13(24), 7796; https://doi.org/10.3390/jcm13247796 - 20 Dec 2024
Cited by 1 | Viewed by 635
Abstract
Background: Despite the prevalence of impaired renal function in acute heart failure (AHF) patients, the intricate relationship between glomerular, tubular, and metabolic renal function remains unexplored. We aimed to investigate the co-occurrence of glomerular, tubular, and metabolic renal dysfunction in AHF and [...] Read more.
Background: Despite the prevalence of impaired renal function in acute heart failure (AHF) patients, the intricate relationship between glomerular, tubular, and metabolic renal function remains unexplored. We aimed to investigate the co-occurrence of glomerular, tubular, and metabolic renal dysfunction in AHF and their impact on prognosis. Methods: eGFR, spot urine sodium, and HCO3− were measured in 243 patients hospitalized for AHF. The population was stratified by the 4-point renal dysfunction score and linked with outcomes. Results: Glomerular dysfunction exhibited an elevated risk of death (HR of 2.04; 95% CI [1.24–3.36]; p = 0.006), combined risk of death, and HF rehospitalization (HR of 2.03; 95% CI [1.34–3.05]; p = 0.005). Similarly, tubular dysfunction correlated with a higher death risk (HR of 1.72; 95% CI [1.04–2.82]; p = 0.03) and a higher combined risk (HR of 1.82; 95% CI [1.21–2.74]; p = 0.004). While renal metabolic dysfunction was linked to increased death risk (HR of 1.82; 95% CI [1.07–3.11]; p = 0.028), it was not associated with composite risk (HR of 1.37; 95% CI [0.88–2.15]; p = 0.174). Multivariate analysis revealed a direct association between the renal dysfunction score and death risk (HR of 1.92 per 1 point; 95% CI [1.47–2.52]; p < 0.0001) and the combined risk of death and HF rehospitalization (HR of 1.78 per 1 point; 95% CI [1.43–2.22]; p < 0.0001). Conclusions: Renal dysfunction is common, with varied overlaps. Glomerular, tubular, and metabolic dysfunctions predict adverse outcomes in AHF. The established renal score may aid patient stratification and prognosis. Full article
(This article belongs to the Special Issue Clinical Challenges in Heart Failure Management)
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Review

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13 pages, 1156 KiB  
Review
Heart Failure Beyond the Diagnosis: A Narrative Review of Patients’ Perspectives on Daily Life and Challenges
by Michelle Shigi Yang, Mohamed Bilal Abdallah, Zubair Bashir and Wissam Khalife
J. Clin. Med. 2024, 13(23), 7278; https://doi.org/10.3390/jcm13237278 - 29 Nov 2024
Viewed by 1422
Abstract
Heart failure (HF) is a complex syndrome that significantly affects patients’ physical, psychological, and socioeconomic well-being. Despite advances in guideline-directed medical therapy (GDMT), such as ACE inhibitors, beta-blockers, and SGLT2 inhibitors, HF continues to have a high global burden, with over 64 million [...] Read more.
Heart failure (HF) is a complex syndrome that significantly affects patients’ physical, psychological, and socioeconomic well-being. Despite advances in guideline-directed medical therapy (GDMT), such as ACE inhibitors, beta-blockers, and SGLT2 inhibitors, HF continues to have a high global burden, with over 64 million affected worldwide and a five-year mortality rate of 50%. HF disrupts various life aspects, especially for younger patients (aged 35–55), who often face career interruptions due to severe symptoms like fatigue and frequent hospitalizations. These patients may struggle to maintain employment, resulting in financial instability compounded by high healthcare costs. Moreover, reduced exercise capacity and sexual dysfunction negatively impact patients’ quality of life. The psychological toll of HF is profound, with many patients experiencing depression, anxiety, and stress. However, a positive mindset has been shown to improve survival rates, underscoring the need for holistic management approaches. Interventions like cognitive behavioral therapy (CBT) and remote monitoring technologies such as CardioMEMS offer promising avenues to improve quality of life and reduce hospitalizations. This review highlights the importance of a multidisciplinary, patient-centered approach to HF management. Tailoring care to align with individual goals, integrating psychosocial support, and enhancing patient education are vital in addressing both the clinical and personal challenges of HF. By adopting a comprehensive approach, healthcare providers can significantly improve long-term outcomes and quality of life for HF patients. Full article
(This article belongs to the Special Issue Clinical Challenges in Heart Failure Management)
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