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Personalized Treatment for Heart Failure
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Personalized Treatment for Heart Failure

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Personalized Therapy in Clinical Medicine".

Deadline for manuscript submissions: 31 July 2026 | Viewed by 5758

Special Issue Editor

Dr. Shunsuke Kiuchi

E-Mail Website
Guest Editor
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-8541, Japan
Interests: heart failure; prevention

Special Issue Information

Dear Colleagues,

Heart failure (HF) is classified into three types based on left ventricular contractility (ejection fraction (EF)). HF-reduced EF has been established to be treated with many cardioprotective medications, including the fantastic four. On the other hand, cardioprotective medications that have evidence of HF mildly reduced EF (HFmrEF) and HF-preserved EF (HFpEF) are sodium/glucose cotransporter 2 inhibitors only, and their treatment is often difficult. However, in an aging society, HFmrEF and HFpEF are on the rise. Therefore, especially in these types of HF, it is also important to suppress their progression to the symptomatic HF stage (stage C HF). Hypertension (HT) is a major cause of decreased cardiac diastolic function in HFpEF, and blood pressure control is possible to suppress symptomatic HF; however, the mechanism behind this is poorly understood.

The aim of this Special Issue is to bring new inspiration to daily clinical practice by discussing the mechanisms that induce HF in patients with HT.

In this Special Issue, we are broadly soliciting reports on epidemiological studies and original research on HT and HF. Reviews are also welcome. We look forward to receiving your contributions.

Dr. Shunsuke Kiuchi
Guest Editor

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 250 words) can be sent to the Editorial Office for assessment.

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 Personalized Medicine is an international peer-reviewed open access monthly 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

  • hypertension
  • heart failure
  • prevention
  • left ventricular contractility
  • cardiovascular outcomes
  • cardiology

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Published Papers (4 papers)

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Research

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12 pages, 351 KB  
Article
Nationwide Trends in Demographics, Comorbidities, and Mortality Among Elderly Patients with Heart Failure with Preserved Ejection Fraction Hospitalized with Cardiac Arrest
by Adil Sarvar Mohammed, Maya Asami Takagi, Umera Yasmeen, Aashna Gandhi, Ayesha Firdous Shafiulla Khan, Apurva Popat, Rupak Desai, Shrinivas Kambali, Ahmad Khalil A. Koshak and Sohaib Mandoorah
J. Pers. Med. 2025, 15(11), 559; https://doi.org/10.3390/jpm15110559 - 18 Nov 2025
Viewed by 299
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is a major cause of hospitalization and mortality in older adults. Sudden cardiac arrest (SCA) is a leading cause of death in this population, yet national trends in incidence, outcomes, and disparities remain poorly defined. [...] Read more.
Background: Heart failure with preserved ejection fraction (HFpEF) is a major cause of hospitalization and mortality in older adults. Sudden cardiac arrest (SCA) is a leading cause of death in this population, yet national trends in incidence, outcomes, and disparities remain poorly defined. Methods: We performed a retrospective cohort study using the National Inpatient Sample from 2016 to 2020. Hospitalizations for patients aged ≥65 years with HFpEF and in-hospital cardiac arrest (CA) were identified using ICD-10-CM codes. Demographics, comorbidities, hospital outcomes, and temporal trends were examined. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, hospital charges, and discharge disposition. Results: Among 7,738,108 HFpEF admissions, 93,440 (1.2%) involved CA. Incidence rose from 1.1% in 2016 to 1.5% in 2020 (36% relative increase). The median age was 81 years; 54% were female, 70% White, 19% Black, and 8% Hispanic. CA incidence increased across all groups, with the largest relative rises among Native American (1.0% to 1.9%), Black (1.7% to 2.3%), and Hispanic patients (1.4% to 2.0%). In-hospital mortality was high, increasing from 58.2% to 61.7% over the study period (p < 0.001). Mortality rose most steeply among Black and low-income patients. Comorbidity patterns shifted toward greater metabolic complexity, including higher rates of complicated diabetes, hypertension, hyperlipidemia, and obesity. Conclusions: Elderly patients hospitalized with HFpEF are experiencing rising rates of in-hospital CA and persistently high mortality, with marked racial and socioeconomic disparities. These findings highlight the need for better risk stratification, targeted metabolic and inflammatory therapies, and more equitable care delivery. Full article
(This article belongs to the Special Issue Personalized Treatment for Heart Failure)
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13 pages, 866 KB  
Article
Phenotype-Guided Outpatient Levosimendan as a Bridge-to-Transplant in Low-Output Advanced Heart Failure: A Single-Center Cohort
by Ricardo Carvalheiro, Ana Raquel Santos, Ana Rita Teixeira, João Ferreira Reis, António Valentim Gonçalves, Rita Ilhão Moreira, Tiago Pereira da Silva, Valdemar Gomes, Pedro Coelho and Rui Cruz Ferreira
J. Pers. Med. 2025, 15(10), 473; https://doi.org/10.3390/jpm15100473 - 2 Oct 2025
Viewed by 463
Abstract
Background: Advanced heart failure (HF) carries high morbidity and mortality, and deterioration on the heart transplantation (HT) waiting list remains a major challenge. Intermittent outpatient levosimendan has been proposed as a bridge strategy, but the optimal regimen and its impact on peri-transplant [...] Read more.
Background: Advanced heart failure (HF) carries high morbidity and mortality, and deterioration on the heart transplantation (HT) waiting list remains a major challenge. Intermittent outpatient levosimendan has been proposed as a bridge strategy, but the optimal regimen and its impact on peri-transplant outcomes remain uncertain. Within a personalized-medicine framework, we targeted a low-output/INTERMACS 3 phenotype and operationalized an adaptable, protocolized levosimendan pathway focused on perfusion/congestion stabilization to preserve transplant candidacy. Methods: We conducted a single-center, retrospective cohort study of 25 consecutive adults actively listed for HT between 2019 and 2024, treated with a standardized outpatient program of a 14-day interval of 6 h intravenous levosimendan infusions (target 0.2 μg/kg/min infusions) continued until transplant. Personalization in this program was operationalized through (i) phenotype-based eligibility (low CI and elevated filling pressures despite GDMT), (ii) predefined titration and safety rules for blood pressure, arrhythmias, and renal function, and (iii) individualized continuation until transplant with nurse-supervised monitoring and review of patient trajectories. Baseline characteristics, treatment exposure and safety, changes in hospitalizations and biomarkers, and peri-transplant outcomes were analyzed. Results: Patients were predominantly male (68%), with a mean age of 47.9 ± 17.5 years and severe LV dysfunction (LVEF 30.6 ± 9.8%). Median treatment duration was 131 days (IQR 60–241). No infusions required discontinuation for hypotension or arrhythmia, and no adverse events were directly attributed to levosimendan. Two patients (8%) died on the waiting list, both unrelated to therapy. During treatment, HF hospitalizations decreased significantly compared with the previous 6 months (48% vs. 20%, p = 0.033), renal function remained stable, and NT-proBNP trended downward. Of the 23 patients transplanted, two (9%) underwent urgent HT during decompensation. Post-transplant, vasoplegia occurred in 26% (n = 6 of 23), and 30-day mortality was 9% (n = 2 of 23). Conclusions: By defining the target phenotype, therapeutic goals, and adaptation rules, this study shows how a standardized but flexible outpatient levosimendan regimen can function as a personalized bridge strategy for low-output advanced HF. The approach was associated with fewer hospitalizations, stable renal function, and acceptable peri-transplant outcomes, and merits confirmation in multicenter cohorts with attention to patient heterogeneity and treatment effect refinement. Full article
(This article belongs to the Special Issue Personalized Treatment for Heart Failure)
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12 pages, 546 KB  
Article
Combination of SGLT2 Inhibitors and Loop Diuretics in the Treatment of Heart Failure
by Yoshiki Murakami, Shunsuke Kiuchi, Shinji Hisatake and Takanori Ikeda
J. Pers. Med. 2025, 15(3), 99; https://doi.org/10.3390/jpm15030099 - 3 Mar 2025
Viewed by 2511
Abstract
Background: Administration of SGLT2 inhibitors leads to a reduction in the dosage of loop diuretics in heart failure (HF) patients; however, it is unclear in what patients the dosage can be reduced. We investigated the factors related to the reduction in loop diuretics [...] Read more.
Background: Administration of SGLT2 inhibitors leads to a reduction in the dosage of loop diuretics in heart failure (HF) patients; however, it is unclear in what patients the dosage can be reduced. We investigated the factors related to the reduction in loop diuretics in patients who have started receiving dapagliflozin, an SGLT2 inhibitor. Methods: In total, 126 consecutive patients with HF who received dapagliflozin for HF at our institution between December 2020 and March 2022 were enrolled. We investigated the change in the dosage of diuretics at the time of dapagliflozin administration and after 6 months and evaluated factors at the time of dapagliflozin initiation that were associated with the dosage of loop diuretic reduction. Results: The median of loop diuretics dosage (oral furosemide equivalent) at the time of dapagliflozin administration was 20 mg/day (the mean dosage; 29.5 ± 26.5 mg/day), and after 6 months it decreased to 10 mg/day (the mean dosage; 14.5 ± 15.9 mg/day) (p < 0.001). Multivariate analysis showed that the three factors of in-hospital start of dapagliflozin, % patients on β-blockers, and the dosage of loop diuretics independently predicted the reduction in loop diuretic dosage. Even in analyses excluding patients who initiated dapagliflozin during hospitalization, loop diuretic dosage independently predicted loop diuretic reduction in multivariate analysis. The receiver operating characteristic curve for predicting reduced loop diuretic showed that the cut-off value for loop diuretic at the time of administration of dapagliflozin was 20 mg/day of oral furosemide equivalent. Conclusions: The dosage of loop diuretic used when dapagliflozin was started is a factor that predicts a subsequent reduction in the dose of loop diuretics. Full article
(This article belongs to the Special Issue Personalized Treatment for Heart Failure)
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Review

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21 pages, 360 KB  
Review
Prognostic Models in Heart Failure: Hope or Hype?
by Spyridon Skoularigkis, Christos Kourek, Andrew Xanthopoulos, Alexandros Briasoulis, Vasiliki Androutsopoulou, Dimitrios Magouliotis, Thanos Athanasiou and John Skoularigis
J. Pers. Med. 2025, 15(8), 345; https://doi.org/10.3390/jpm15080345 - 1 Aug 2025
Cited by 2 | Viewed by 1861
Abstract
Heart failure (HF) poses a substantial global burden due to its high morbidity, mortality, and healthcare costs. Accurate prognostication is crucial for optimizing treatment, resource allocation, and patient counseling. Prognostic tools range from simple clinical scores such as ADHERE and MAGGIC to more [...] Read more.
Heart failure (HF) poses a substantial global burden due to its high morbidity, mortality, and healthcare costs. Accurate prognostication is crucial for optimizing treatment, resource allocation, and patient counseling. Prognostic tools range from simple clinical scores such as ADHERE and MAGGIC to more complex models incorporating biomarkers (e.g., NT-proBNP, sST2), imaging, and artificial intelligence techniques. In acute HF, models like EHMRG and STRATIFY aid early triage, while in chronic HF, tools like SHFM and BCN Bio-HF support long-term management decisions. Despite their utility, most models are limited by poor generalizability, reliance on static inputs, lack of integration into electronic health records, and underuse in clinical practice. Novel approaches involving machine learning, multi-omics profiling, and remote monitoring hold promise for dynamic and individualized risk assessment. However, these innovations face challenges regarding interpretability, validation, and ethical implementation. For prognostic models to transition from theoretical promise to practical impact, they must be continuously updated, externally validated, and seamlessly embedded into clinical workflows. This review emphasizes the potential of prognostic models to transform HF care but cautions against uncritical adoption without robust evidence and practical integration. In the evolving landscape of HF management, prognostic models represent a hopeful avenue, provided their limitations are acknowledged and addressed through interdisciplinary collaboration and patient-centered innovation. Full article
(This article belongs to the Special Issue Personalized Treatment for Heart Failure)
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