Heart Failure – What Do We Need to Know? The Latest Scientific Discoveries

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Introduction

Heart failure is one of the most serious and rapidly growing health challenges of our time, affecting millions of people worldwide and significantly impacting both the length and quality of their lives. While advances in medicine have led to new therapeutic options and improved diagnostics, the condition remains associated with high mortality and frequent hospitalizations.

This article is based on a summary and analysis of the leading scientific review “Heart failure in the last year: progress and perspective”, published in 2020 in the journal ESC Heart Failure. Its authors—Daniela Tomasoni, Marianna Adamo, Markus Anker, Stefan von Haehling, Andrew J.S. Coats, and Marco Metra—are respected cardiology experts and researchers affiliated with universities in Brescia (Italy), Berlin and Göttingen (Germany), as well as IRCCS San Raffaele in Rome (Italy). They synthesize the latest data, clinical studies, and expert recommendations on the current state of diagnostics, treatment, and trends in heart failure.

In the following sections, you’ll find selected questions and answers that can be most helpful for any patient or loved one facing this condition—with a focus on practical, evidence-based, and up-to-date insights from global medicine.

“Despite advances in treatment, mortality in heart failure remains higher than in most types of cancer—which is why awareness and early diagnosis are critical for every patient.”

Expert Opinions

Heart failure continues to be one of the greatest health and socio-economic challenges worldwide, affecting millions of patients regardless of age, gender, or region. In recent years, significant progress has been made in understanding, diagnosing, and treating this condition. At the same time, several aspects—such as personalized therapy, comorbidities, innovative drugs, and devices—remain subjects of intense scientific debate. Below, you’ll find five selected opinions and quotes from recognized experts and researchers outlining the key strategies for better prognosis, more effective treatment, and more informed patient participation.

1. What’s new and truly effective in treating heart failure with reduced ejection fraction (HFrEF)? 

Quote:

“Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM‐HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA‐HF and EMPEROR‐Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo… Vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo.” (p. 3505–3506)

Explanation: In recent years, revolutionary therapies—such as sacubitril/valsartan, SGLT2 inhibitors (dapagliflozin and empagliflozin), and vericiguat—have significantly improved survival and reduced hospitalizations. If you’re a patient with HFrEF, discuss with your cardiologist whether these medications may be suitable for you.

2. Why are comorbidities so important in heart failure? 

Quote:

“Co‐morbidities play a major role in the clinical presentation and outcomes of HF. More than 70% of patients with HF are burdened by co‐morbidities, and they have an independent effect on mortality.” (p. 3507)

Explanation: Conditions like diabetes, kidney disease, anemia, chronic obstructive pulmonary disease (COPD), malnutrition, and others can significantly worsen prognosis. Don’t neglect the treatment and control of comorbidities! Managing your overall health is key to a longer and better-quality life.

3. What are the newest biomarkers and tests for diagnosing and monitoring heart failure? 

Quote:

“Plasma levels of natriuretic peptides (NPs) are related with LV wall stress and are surrogates for intracardiac filling pressures. They are useful to discriminate HF from non‐cardiac breathlessness in patients presenting to the emergency department. Lower levels of NPs have a very high negative predictive value for the diagnosis of HF... NPs, along with troponin, are the most useful biomarkers to predict outcomes in both chronic and acute HF to date.” (p. 3508)

Explanation: NT-proBNP and troponin remain the gold standard for both diagnosis and prognosis. If heart failure is suspected, insist on testing for these markers—they help your doctor reach a timely and accurate diagnosis.

4. When should a device (CRT, ICD) or interventional treatment be considered? 

Quote:

“Cardiac resynchronization therapy (CRT) is less frequently used than expected, even when indicated by guidelines... QRS duration was the only independent predictor of CRT benefit on mortality. ...Implantable cardioverter defibrillator (ICD) ...was associated with a reduced risk of mortality in non‐diabetic patients but not among those with diabetes.” (p. 3511)

Explanation: If you have significant electrical dysfunction (prolonged QRS), talk to your doctor about CRT—this device has been proven to reduce mortality and improve quality of life. ICDs are recommended for patients at high risk of sudden cardiac death, but their benefit depends on your individual health profile.

5. What are the trends in heart failure with preserved ejection fraction (HFpEF), and what are the hopes for patients? 

Quote:

“Heart failure with preserved ejection fraction is a heterogeneous syndrome with several clinical manifestations... Despite the growing impact of HFpEF, there is still no established pharmacological therapy. ...Better patient phenotyping seems the next promising step. However, this hypothesis needs testing in properly designed clinical studies.” (p. 3513–3515)

Explanation: HFpEF presents a unique challenge—there’s no specific medication that clearly improves outcomes. The key lies in an individualized approach, managing risk factors, and the future of personalized medicine.

Questions & Answers

1. How serious is heart failure compared to other diseases? 

Answer: Heart failure remains a condition with high mortality, even after decades of progress:

“Despite an improvement in 5 year survival rates between 1970–1979 and 2000–2009 from 29.1% to 59.7%, mortality rates remain unacceptably high and larger than for most types of cancer.” (p. 3506) This means that while treatment has improved, heart failure is often more serious than some types of cancer and should not be underestimated.

2. Why is my diagnosis sometimes so difficult, and can it be improved? 

Answer: Diagnosing heart failure—especially HFpEF—is complex because of its many causes and varied presentation:

“The diagnosis of HFpEF remains challenging. Recently, two independently derived algorithms for the HFpEF diagnosis have been published: the H2FPEF score ... and the European HFA‐PEFF 4‐step algorithm.” (p. 3513) This shows that more specialized diagnostic approaches are being introduced, combining symptoms, echocardiography, and lab tests for more timely and accurate detection.

3. How do age, gender, and location affect my prognosis? 

Answer: Research shows that:

“Trends in HF hospitalizations from 2000 to 2014 were examined in Norway... Although mortality was reduced, HF rehospitalizations increased.” (p. 3506) And that there are significant geographic differences: “Several studies have highlighted the regional heterogeneity of HF populations, patients’ characteristics, and outcomes, with important implications for global trial design.” (p. 3506) Gender and age also matter: for example, women and Asians have different risk profiles and mortality rates. This suggests that treatment and prognosis are highly individualized, influenced not just by the disease but also by your personal characteristics and where you live.

4. What are the most common comorbidities that can worsen my condition? 

Answer: More than 70% of patients with heart failure have other serious illnesses:

“Type 2 diabetes mellitus confers a greater risk of new onset HF, HF rehospitalization, and CV and all‐cause mortality... Further common co‐morbidities associated with HF are chronic kidney disease, chronic obstructive pulmonary disease, ... sleep disordered breathing, iron deficiency, cancer, cachexia, muscle wasting (sarcopenia), and frailty.” (p. 3507) Managing and treating these comorbidities is a key part of coping with heart failure.

5. If I need hospitalization or I'm about to be discharged, what should I monitor and discuss with my doctor? 

Answer: A crucial aspect of hospital care is assessing “residual congestion” (leftover fluid retention):

“Clinical residual congestion at discharge was detected in 30.9% of patients ... and it was associated with increased 1 year mortality.” (p. 3514) In other words, if you still have swelling, shortness of breath, or fluid retention at discharge, this is a serious risk factor for readmission or complications. Ongoing treatment and strict follow-up remain essential even after leaving the hospital.

Conclusion

In modern medicine, heart failure remains a condition that requires an integrated and personalized approach—from early and accurate diagnosis to optimal treatment and careful monitoring of comorbidities and risk factors. As shown by the analysis from Tomasoni and colleagues, progress is evident, but the challenges are still significant: high mortality, the need for more precise diagnostic algorithms, complex comorbidities, and the necessity for personalized therapy.

Armed with up-to-date information based on the best scientific sources and clinical practices, patients and their families can make more informed health decisions, while physicians can apply the most suitable and effective treatment strategies. Open communication, symptom tracking, and ongoing dialogue with specialists remain at the heart of the fight against heart failure—a disease that demands teamwork, knowledge, and trust.

Source: Tomasoni, D., Adamo, M., Anker, M.S., von Haehling, S., Coats, A.J.S., & Metra, M. (2020). Heart failure in the last year: progress and perspective. ESC Heart Failure, 7: 3505–3530. DOI: 10.1002/ehf2.13124