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Clinical Management of Patients with Heart Failure—2nd Edition

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

Deadline for manuscript submissions: 13 August 2025 | Viewed by 6221

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Dr. Tudoran Cristina

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1. Center of Molecular Research in Nephrology and Vascular Disease, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
2. Department of Cardiology, County Emergency Hospital “Pius Brinzeu” Timisoara, Timisoara, Romania
Interests: heart failure; systemic hypertension; acute and chronic coronary syndrome; arrhythmias; management of patients with cardiovascular diseases; cardiovascular risk factors
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Dear Colleagues,

I am pleased to invite you to contribute to this Special Issue entitled "Clinical Management of Patients with Heart Failure—2nd Edition". For more details on the first edition, in which we published more than 15 papers, please visit: https://www.mdpi.com/journal/jcm/special_issues/91TCP5E3S2.

Worldwide, one of the leading causes of increased morbidity and mortality is heart failure, which also leads to increased costs for the healthcare systems. It evolves with repeated episodes of decompensation, representing one of the most frequent reasons for hospitalization in the cardiology or internal medicine units, but also aggravating the course of other pathologies. Even in its more stable form, chronic heart failure may affect patients' well-being and quality of life, impacting their level of activity and reducing their possibility of self-care, also generating socio-economic consequences for the diseased persons and their families as well. The onset of heart failure is frequently subtle and unexpected, and this pathology can progress slowly, remaining unnoticed for several years. When patients seek specialized medical advice, it is often too late to obtain optimal results, because several complications and associated co-morbidities are already present, and the most appropriate recommended management must be adapted to their clinical conditions.

In the last decade, along with the progress of fundamental sciences and pharmacotherapy and the prodigious efforts of the cardiology societies and healthcare systems worldwide, new therapeutic methods have been developed, and the availability of specialized medical care for the general population has increased, leading to a better management of patients with heart failure and, in recent years, to an increase in the life expectancy of these subjects. Although a variety of new treatment options are available, starting with innovative drugs, and continuing with invasive procedures, not to forget the lifestyle change measures, selecting the most appropriate management of heart failure is difficult, raising challenges for the medical personnel and healthcare systems, while often leading to suboptimal results for the patient.

This Special Issue focuses on original articles and reviews referring to groundbreaking research regarding the clinical management of heart failure.

Dr. Tudoran Cristina
Guest Editor

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Keywords

acute heart failure
chronic heart failure
treatment options
management of heart failure
life style changes
diagnosis of heart failure

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Related Special Issue

Clinical Management of Patients with Heart Failure in Journal of Clinical Medicine (16 articles)

Published Papers (9 papers)

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Research

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11 pages, 223 KiB

Open AccessArticle

Artificial Sweeteners and Cardiovascular Risk in Hungary: Beyond Traditional Risk Factors

by Battamir Ulambayar and Attila Csaba Nagy

J. Clin. Med. 2025, 14(13), 4641; https://doi.org/10.3390/jcm14134641 - 30 Jun 2025

Cited by 1 | Viewed by 397

Abstract

Background/Objectives: Cardiovascular disease (CVD) remains a leading cause of mortality in Hungary, with rising obesity and diabetes rates exacerbating the burden. Artificial sweeteners, promoted as healthier alternatives to sugar, have been linked to CVD risk in other populations, but evidence in Hungary is limited. This study aims to investigate the association between artificial sweetener use and CVD prevalence in a Hungarian population, independent of traditional risk factors, using data from the 2019 European Health Interview Survey (EHIS). Methods: This cross-sectional study analyzed EHIS data (n = 5603), categorizing participants by self-reported CVD diagnoses (hypertension, coronary artery disease, myocardial infarction, or stroke). Variables included artificial sweetener use, age, sex, education, income, smoking, alcohol consumption, physical activity, diabetes, and body mass index (BMI). Chi-square tests and multivariate logistic regression, adjusted for sampling weights, were employed to assess associations. Results: Of 5603 participants, 38.7% had CVD and 16.4% used artificial sweeteners. Older age, female sex, lower education, long-term smoking cessation, obesity, diabetes, and physical inactivity increased CVD risk, while moderate alcohol consumption and sports were protective. Artificial sweetener use was significantly associated with higher CVD prevalence (OR: 1.21, 95% CI: 1.01–1.46, p = 0.01), independent of other risk factors. Conclusions: Artificial sweetener use is associated with increased CVD risk in Hungary, suggesting a need for further research and public health strategies to address this potential risk. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

15 pages, 640 KiB

Open AccessArticle

Myocardial Performance Improvement After Iron Replacement in Heart Failure Patients: The IRON-PATH II Echo-Substudy

by Raúl Ramos-Polo, Maria del Mar Ras-Jiménez, María del Carmen Basalo Carbajales, Sílvia Jovells-Vaqué, José Manuel Garcia-Pinilla, Marta Cobo-Marcos, Javier de Juan-Bagudá, Cândida Fonseca, Josep Francesch Manzano, Andreea Eunice Cosa, Sergi Yun-Viladomat, Cristina Enjuanes, Marta Tajes Orduña and Josep Comin-Colet

J. Clin. Med. 2025, 14(12), 4048; https://doi.org/10.3390/jcm14124048 - 7 Jun 2025

Viewed by 507

Abstract

Background: Iron deficiency (ID) is a commonly seen comorbidity in heart failure (HF) patients. It is often associated with a poor prognosis and impaired physical capacity. The functional limitations linked to ID may lead to cardiac function abnormalities. The functional limitations linked to ID may lead to cardiac function abnormalities, that can be reversible after iron repletion. Some echocardiographic parameters, such as global longitudinal strain (GLS), myocardial work (MW) and its derivatives constructive work (CW), wasted work (WW) and work efficiency (WE), may be of added value in advanced cardiac performance assessment. Methods: IRON-PATH II was a multicenter, prospective and observational study designed to describe the pathophysiological pathways associated with ID. The echo-substudy included 100 HF patients that had undergone a specific pilot echocardiographic evaluation. Patients had a left ventricular ejection fraction (LVEF) ≤50%, were in stable clinical condition and on standard HF medication with hemoglobin ≥11 g/dL. The final cohort included 98 patients. Results: The ID group showed worse cardiac function, with lower GLS (−8.5 ± 9% vs. −10 ± 10%), WE (74 ± 10% vs. 80 ± 10%) and MW (665 [453–1013] vs. 947 [542–1199] mmHg%), as well as higher WW (290 [228–384] vs. 212 [138–305] mmHg%) and lower RV free wall strain (−13 [−20–(−11)]% vs. −17 [−23–(−14)]%). Following iron repletion, ID patients demonstrated improved LV (GLS, MW, WE and WW) and RV performance (RV free wall strain), aligning with non-ID patients (all p-values >0.05 compared to the non-ID group). Conclusions: Among HF patients with reduced LVEF, ID was associated with worse myocardial performance in both the LV and RV. All the alterations seen were reversible after intravenous iron repletion. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

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15 pages, 1066 KiB

Open AccessArticle

Effect of Coenzyme Q10 Supplementation on Cardiac Function and Quality of Life in Patients with Heart Failure: A Randomized Controlled Trial

by Olivia Bodea, Eugen Radu Boia, Laura Maria Craciun, Mihaela Daniela Valcovici, Alexandru Catalin Motofelea, Andreea Mara Munteanu, Caius Glad Streian, Gheorghe Nicusor Pop and Simona Ruxanda Dragan

J. Clin. Med. 2025, 14(11), 3675; https://doi.org/10.3390/jcm14113675 - 23 May 2025

Viewed by 1882

Abstract

Background/Objectives: Heart failure remains a complex syndrome with high morbidity and mortality, highlighting the urgent need for alternative treatments that address underlying bioenergetic impairments. CoQ10, which plays a crucial role in mitochondrial ATP production, has shown promising results in small studies, although larger trials are needed to confirm its efficacy. Results: This randomized controlled trial investigated the effects of coenzyme Q10 (CoQ10) supplementation on cardiac function and quality of life in heart failure patients. A total of 120 patients were randomly assigned to receive either CoQ10 (2 × 60 mg daily) or a placebo for six months. Baseline characteristics were similar between groups. The primary outcomes were changes in global longitudinal strain (GLS) and left ventricular ejection fractions (LVEFs), while secondary outcomes included improvements in functional capacity and quality of life. At the 6-month endpoint, the CoQ10 group showed significant improvements in GLS (−11.7% to −14.9%, p < 0.001), NT-proBNP levels (815.6 vs. 1378.5 pg/mL, p = 0.012), blood pressure, and 6 min walk test distance (349.3 vs. 267.0 m, p = 0.008) compared to the placebo group. LVEFs improved slightly in the CoQ10 group (38.9% to 40.6%, p = 0.170) but remained unchanged in the placebo group. Conclusions: These findings suggest that CoQ10 supplementation may improve cardiac function, reduce cardiac stress, and enhance functional capacity and quality of life in heart failure patients. Further research is needed to optimize dosage and identify the subgroups that may benefit most from CoQ10 therapy. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

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10 pages, 776 KiB

Open AccessArticle

Guideline-Directed Medical Therapy in Sepsis Survivors with Left Ventricular Systolic Dysfunction: An Observational Study

by Thomas Oswald, Samuel Malomo, Thomas Alway, Stanislav Hadjivassilev, Steven Coombs, Susan Ellery, Joon Lee, Claire Phillips, Barbara Philips, Rachael James, David Hildick-Smith, Victoria Parish and Alexander Liu

J. Clin. Med. 2025, 14(9), 3253; https://doi.org/10.3390/jcm14093253 - 7 May 2025

Viewed by 548

Abstract

Background: Sepsis survivors can develop left ventricular systolic dysfunction (LVSD) and heart failure. These patients are often treated with guideline-directed medical therapy (GDMT) known to be effective in patients with non-sepsis-related heart failure. This study sought to assess the use of GDMT on sepsis survivors with LVSD. Methods: Sepsis survivors with suspected myocardial injury and/or heart failure diagnosed with LVSD in a UK cardiac centre were retrospectively studied. Clinical and transthoracic echocardiography (TTE) data were recorded and analysed. Results: Of the 25 sepsis survivors (age 56 ± 11 years; 52% males), 11 (44%) had LVSD (LVEF < 50%). LV end-diastolic internal diameter (LVIDd) was similar between patients with vs. without LVSD (5.2 ± 0.8 cm vs. 4.7 ± 0.8 cm; p = 0.214). Patients with LVSD had significantly greater LV end-systolic internal diameter (LVIDs) than those without LVSD (4.0 ± 1.2 cm vs. 2.8 ± 0.6 cm; p = 0.027). Tricuspid annular plane systolic excursion (TAPSE) was similar between the two groups (2.1 ± 0.5 cm vs. 2.2 ± 0.6 cm; p = 0.910). Of the 11 patients with LVSD, nine patients underwent repeat TTE scans after 6 months [IQR 3–9], most of whom were taking GDMT. The majority (8/9) of these patients demonstrated LV systolic functional recovery (>5% LVEF increase; mean LVEF improvement 16 ± 11%) after GDMT. Reductions were seen in LVIDd (5.3 ± 0.8 cm to 5.0 ± 0.7 cm) and LVIDs (4.1 ± 1.2 cm to 3.7 ± 0.8 cm) after GDMT, though these changes did not reach statistical significance (both p > 0.05). Conclusions: GDMT appears beneficial in sepsis survivors with LV dysfunction. This finding should be validated on a larger and multi-centre basis to further affirm the value of medical therapy in post-sepsis heart failure. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

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Review

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21 pages, 749 KiB

Open AccessReview

HDL Function Versus Small Dense LDL: Cardiovascular Benefits and Implications

by Claudiu Stoicescu, Cristina Vacarescu and Dragos Cozma

J. Clin. Med. 2025, 14(14), 4945; https://doi.org/10.3390/jcm14144945 - 12 Jul 2025

Viewed by 396

Abstract

High-density lipoprotein (HDL) and small dense low-density lipoprotein (sdLDL) represent two critical yet contrasting components in lipid metabolism and cardiovascular risk modulation. While HDL has traditionally been viewed as cardioprotective due to its role in reverse cholesterol transport and anti-inflammatory effects, emerging evidence emphasizes that HDL functionality—rather than concentration alone—is pivotal in atheroprotection. Conversely, sdLDL particles are increasingly recognized as highly atherogenic due to their enhanced arterial penetration, oxidative susceptibility, and prolonged plasma residence time. This review critically examined the physiological roles, pathological implications, and therapeutic interventions targeting HDL function and sdLDL burden. Lifestyle modifications, pharmacologic agents including statins, fibrates, PCSK9 inhibitors, and novel therapies such as icosapent ethyl were discussed in the context of their effects on HDL quality and sdLDL reduction. Additionally, current clinical guidelines were analyzed, highlighting a paradigm shift away from targeting HDL-C levels toward apoB-driven risk reduction. Although HDL-targeted therapies remain under investigation, the consensus supports focusing on lowering apoB-containing lipoproteins while leveraging lifestyle strategies to improve HDL functionality. In the setting of heart failure, particularly with preserved ejection fraction (HFpEF), alterations in HDL composition and elevated sdLDL levels have been linked to endothelial dysfunction and systemic inflammation, further underscoring their relevance beyond atherosclerosis. A comprehensive understanding of HDL and sdLDL dynamics is essential for optimizing cardiovascular prevention strategies. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

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18 pages, 309 KiB

Open AccessReview

Prevalence of Healthcare-Associated Infections in Patients with Cardiovascular Diseases: A Literature Review

by Daniela-Mirela Vîrtosu, Angela Munteanu Dragomir, Simina Crișan, Silvia Luca, Oana Pătru, Ruxandra-Maria Băghină, Mihai-Andrei Lazăr, Alina-Ramona Cozlac, Stela Iurciuc and Constantin-Tudor Luca

J. Clin. Med. 2025, 14(14), 4941; https://doi.org/10.3390/jcm14144941 - 12 Jul 2025

Viewed by 289

Abstract

This review aims to summarize the global prevalence of healthcare-associated infections in patients with acute heart failure who have been admitted to coronary care units, highlighting the underrepresented burden of infection in this high-risk population. Coronary care units (CCUs) play a pivotal role in the care of patients experiencing acute or decompensated heart failure, offering a highly monitored environment with immediate access to advanced cardiac interventions. The management of heart failure in CCUs involves a multidisciplinary approach that includes hemodynamic monitoring, pharmacologic therapy, respiratory support, and, in selected cases, mechanical circulatory assistance. The early identification of deterioration, rapid therapeutic escalation, and close monitoring of cardiac function are hallmarks of CCU care. However, the complexity and severity of illness in this population are compounded by a high risk of infections, including hospital-acquired pneumonia, bloodstream infections, and device-related infections. These infections not only increase morbidity and prolong hospitalization but also significantly impact mortality and healthcare costs. The immunocompromised state of many heart failure patients—due to poor perfusion, malnutrition, and the use of invasive devices—further elevates their vulnerability. Effective infection prevention, early diagnosis, and targeted antimicrobial therapy are, therefore, critical components of heart failure management within CCUs. This intersection of advanced cardiac care and infection control highlights the need for integrated, multidisciplinary strategies to improve outcomes in this high-risk population. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

27 pages, 849 KiB

Open AccessReview

Historical Gaps in the Integration of Patient-Centric Self-Management Components in HFrEF Interventions: An Umbrella Narrative Review

by Pupalan Iyngkaran, Fareda Fazli, Hayden Nguyen, Taksh Patel and Fahad Hanna

J. Clin. Med. 2025, 14(8), 2832; https://doi.org/10.3390/jcm14082832 - 19 Apr 2025

Viewed by 570

Abstract

Background: Chronic disease self-management (CDSM) interventions have shown promise in improving patient outcomes in heart failure (HF), particularly for those with reduced ejection fraction (HFrEF). Patient-centric self-management programs often incorporate key components such as education, self-monitoring, and goal setting. However, the extent to which these components are consistently reported and integrated into studies remains unclear. This umbrella narrative review aims to analyze systematic reviews to assess the consistency of reporting on patient-centric self-management components implemented in trials and studies. Methods: This umbrella narrative review synthesized findings from systematic reviews and meta-analyses published between 2000 and 2023 for CDSM tools in HF. Eligible studies were assessed for the presence and consistency of reporting on education, self-monitoring, and goal setting in self-management interventions for HFrEF. Data extraction focused on the frequency of reporting these components and the gaps in reporting long-term patient outcomes. Results: Among the included systematic reviews, education was the most consistently reported component (100%), while self-monitoring and goal setting were each reported in around 50% of studies. Reporting of long-term outcomes, such as mortality and quality of life, was highly variable and often absent. These inconsistencies highlight significant gaps in the evidence base for CDSM interventions. Conclusions: This review identifies gaps in the consistent reporting of key CDSM components in systematic reviews of HFrEF interventions. The inconsistent inclusion of all three components together and limited reporting of long-term outcomes may hinder the development of a robust evidence base for the adoption of these tools in HF guidelines. Future studies should prioritize comprehensive reporting to strengthen the foundation for patient-centric self-management strategies in HF care. PROSPERO registration number CRD42023431539. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

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Other

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31 pages, 3140 KiB

Open AccessSystematic Review

Refining Patient Selection Criteria for LV-Only Fusion Pacing in Cardiac Resynchronization Therapy: A Systematic Review

by Adelina Andreea Faur-Grigori, Cristina Văcărescu, Samuel Nistor, Silvia Ana Luca, Cirin Liviu, Simina Crișan, Constantin-Tudor Luca, Radu-Gabriel Vătășescu and Dragoș Cozma

J. Clin. Med. 2025, 14(14), 4853; https://doi.org/10.3390/jcm14144853 - 8 Jul 2025

Viewed by 320

Abstract

Objectives: This review aims to systematically evaluate the clinical outcomes of left ventricle-only fusion pacing (LV-only fCRTp) and identify evidence-based selection criteria that may optimize patient response and long-term therapeutic benefit. Background: Cardiac resynchronization therapy (CRT) is traditionally associated with biventricular pacing (BiVp). However, approximately 20–40% of patients seem to remain non-responders to this therapy. LV-only fCRTp offers a more physiological alternative by combining left ventricular epicardial pacing with the intrinsic ventricular activation wavefront. Beyond optimization strategies, the observed variability in response highlights the need for better patient selection in order to fully unlock its therapeutic potential. Methods: A systematic literature search was conducted in PubMed and Cochrane Library for original articles published up to April 2025, following PRISMA 2020 guidelines. The search focused on LV-only fCRTp performed either through standard RA/LV/RV biventricular devices or RA/LV dual-chamber systems. Results: Twenty-seven studies met the inclusion criteria. Among these, 17 studies obtained LV-only fCRTp using biventricular devices, and 10 were considered true LV-only fCRTp using RA/LV dual-chamber devices. Standard and specific selection criteria were used to qualify patients for LV-only fCRTp. Preserved atrioventricular conduction, ischemic cardiomyopathy, arrhythmic risk stratification, and the management of supraventricular arrhythmias were common overlapping parameters among studies with high variability, highlighting their potential role in response. RA/LV devices yielded consistent clinical benefits and low complication rates, particularly in nonischemic patients with stable AV conduction and low arrhythmic risk, while having a lower financial burden. Conclusions: Beyond guideline recommendations for CRT, this review identifies supplementary selection criteria that could further influence the effectiveness and stability of fusion pacing. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

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13 pages, 867 KiB

Open AccessSystematic Review

The Role of ARNI in Enhancing Outcomes of Cardiac Resynchronization Therapy: A Comprehensive Review

by Oana Pătru, Silvia Luca, Dragoș Cozma, Cristina Văcărescu, Simina Crișan, Mihaela Daniela Valcovici, Mirela Vîrtosu, Adrian Sebastian Zus, Constantin Tudor Luca and Simona Ruxanda Drăgan

J. Clin. Med. 2025, 14(8), 2743; https://doi.org/10.3390/jcm14082743 - 16 Apr 2025

Cited by 2 | Viewed by 760

Abstract

Background/Objectives: Cardiac resynchronization therapy (CRT) and angiotensin receptor–neprilysin inhibitors (ARNIs) are cornerstone therapies for patients with heart failure with reduced ejection fraction (HFrEF). However, nearly 30% of patients show no significant response to CRT alone. The potential of ARNI to enhance CRT outcomes—especially in non-responders—is an emerging field of interest. The objective of this review is to systematically evaluate and synthesize the available evidence on the clinical outcomes of combining CRT with ARNI therapy in patients with HFrEF. Methods: We conducted a comprehensive search of PubMed, Scopus, and Google Scholar up to September 2024, using the keywords “CRT and ARNI” and “cardiac resynchronization therapy and sacubitril/valsartan”. We included retrospective and prospective clinical studies, observational studies, and review articles reporting on patients with HFrEF treated with both CRT and ARNI. Studies not in English, animal studies, and those without full-text availability were excluded. Study selection and data extraction were performed in duplicate by independent reviewers, using PRISMA guidelines for transparency. The final selection included 8 studies published in the last four years, summarized by design, population, outcomes, and statistical significance. Results: The reviewed studies suggest that ARNI therapy, when combined with CRT, may contribute to improvements in left ventricle ejection fraction (LVEF), NYHA functional class, and ventricular remodeling, particularly in CRT non-responders. Some studies also report a potential reduction in ventricular arrhythmias and implantable cardioverter-defibrillator (ICD) interventions. However, outcomes varied across subgroups, and the influence of ARNI timing relative to CRT implantation remains inconclusive. Limitations: Heterogeneity in study designs and small sample sizes in some included studies limited the ability to conduct a meta-analysis. This review is not registered. Conclusions: ARNI therapy shows promise in enhancing CRT response in patients with HFrEF, particularly in non-responders. Further large-scale, prospective studies are needed to clarify optimal patient selection and treatment sequencing. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

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