Global Cardiology
type: channel
description: The Global Cardiology journal is an open access, peer-reviewed international journal that aims to publish original articles, reviews, mini reviews, case reports, guidelines, white papers, news, meeting reports, plain language summaries, editorials and letters to the editor related to the diagnosis, treatment, and prevention of cardiovascular diseases. The scope of the journal includes all aspects of basic, translational and clinical science in cardiology, including but not limited to coronary artery disease, heart failure, cardiomyopathies, arrhythmias, valvular heart disease, hypertension, congenital heart disease, cardiac imaging, interventional cardiology, cardiac surgery, co-morbidities leading to cardiovascular disease, as well as epidemiology, prevention and rehabilitation of cardiovascular diseases. The journal aims to provide a platform for the dissemination of new knowledge and advancements in the field of cardiology, as well as to promote interdisciplinary collaboration among researchers, clinicians, healthcare professionals and the medically interested public. The target audience of a general cardiology journal includes cardiologists, internists, primary care physicians, researchers, and other healthcare professionals involved in the care of patients with cardiovascular diseases.
publisher: PAGEPress Scientific Publications, Pavia, Italy
language: en
publication name: Global Cardiology
issn: 2975-2728
items: Draft Document for Public Consultation: iCARDIO Alliance Global Implementation Guidelines on Ischemic Heart Disease Management 2026
items: MASLD and cardiovascular disease: a state-of-the-art review
items: Coronary artery calcium scoring. What clinicians need to know
items: The impact of frailty on in-hospital outcomes in patients with HFrEF
items: Aldosterone synthase inhibitors in cardio-renal diseases: a state-of-the-art review
items: Effect of metformin and empagliflozin on myocardial function in insulin-resistant patients with heart failure: rationale and design of the METRIS-HF-DZHK18 Trial
items: Aortic valve replacement in asymptomatic severe aortic stenosis. A focused review
items: iCARDIO Alliance Global Implementation Guidelines for the Management of Obesity 2025 - Focus on prevention and treatment of cardiometabolic disease
items: Frequency of low-density-lipoprotein-cholesterol measurement and risk of major adverse cardiovascular outcomes: a 5-million-person nationwide cohort study
items: Is the obesity paradox present in left ventricular assist device recipients? A BMI-based analysis
items: Demographic and regional trends of heart failure and cachexia-related mortality among older adults in the United States, from 1999 to 2020
items: Iron supplementation in heart failure and iron deficiency: does it help?
items: Advancements in transcatheter tricuspid valve repair and replacement: a state-of-the-art review with echocardiographic outcomes
items: Lipoprotein(a): what clinicians need to know
items: Optimized heart failure therapy in patients with very advanced cancer in palliative care: dosing strategies from the EMPATICC trial
items: Self-administered intranasal etripamil: a breakthrough in PSVT first-line treatment
items: Sex-based differences in characteristics, management, and outcomes in heart failure with reduced ejection fraction
items: Large language models to write scientific manuscripts: to be considered but not trusted
items: Applicability of obesity clinical practice guidelines in low- and middle-income countries
items: Safety and efficacy of left atrial appendage closure in cancer versus non-cancer patients: a systematic review and meta-analysis
items: iCARDIO Alliance Global Implementation Guidelines on Heart Failure 2025
items: Importance of patient-reported outcomes in cardiovascular illnesses
items: Cardiac wasting in patients with advanced cancer: state of the art review
items: Bridging the gap: integrating stress echocardiography, iFR, CFR, and FFR in the evaluation of coronary artery disease
items: https://www.globalcardiology.info/site/article/view/64
items: Impella vs intra-aortic balloon pump in patients with acute myocardial infarction complicated with cardiogenic shock: an updated systematic review and meta-analysis
items: Dyslipidemia and stroke-related mortality in the United States: a nationwide analysis for 2010-2020
items: Sex differences in clinical characteristics and outcomes in heart failure with mildly reduced and preserved ejection fraction
items: The effect of sauna on cardiac and skeletal muscle function in patients with HFpEF (SAUNA-HFpEF): rationale and design
items: The Global Implementation Guidelines Initiative: how to optimize cardio-renal-metabolic care worldwide

Draft Document for Public Consultation: iCARDIO Alliance Global Implementation Guidelines on Ischemic Heart Disease Management 2026
type: item
description: Ischemic heart disease (IHD) remains the leading cause of morbidity and mortality worldwide. Coronary artery disease (CAD) encompasses any pathological process capable of compromising myocardial perfusion and although numerous etiologies exist, including vasculitis, spontaneous coronary artery dissection, and coronary embolism, the majority of CAD is attributable to coronary atherosclerosis, which constitutes the focus of this document. For practical purposes, CAD is considered present when any degree of atherosclerotic involvement exceeds zero percent stenosis, recognizing that even minimal coronary atherosclerosis represents a systemic disease process with prognostic implications.
subject: Guidelines
  topic: section
subject: Case Reports
  topic: category
subject: Guidelines
  topic: category
subject: Guidelines
  topic: keywords
subject: ischemic heart disease
  topic: keywords
creator: Writing Task Force | iCARDIO-Alliance
rights: Copyright (c) 2026 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-05
publication date: 2026-02-05
doi: 10.4081/cardio.2026.95

MASLD and cardiovascular disease: a state-of-the-art review
type: item
description: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease, is the most prevalent chronic liver disease worldwide, affecting more than 30% of adults and up to 70–90% of individuals with obesity or type 2 diabetes mellitus. Cardiovascular disease (CVD) represents the leading cause of mortality in this population. MASLD is increasingly recognized as an independent cardiovascular risk factor beyond traditional metabolic comorbidities. This narrative review summarizes epidemiologic, mechanistic, and clinical evidence linking MASLD with cardiovascular disease, with a focus on population-based cohort studies, imaging-based assessments of subclinical cardiovascular disease, and fibrosis-based risk stratification. Population-based cohorts, including the Framingham Heart Study and the Multi-Ethnic Study of Atherosclerosis, demonstrate that hepatic steatosis is associated with a 1.5–2.0-fold increased risk of incident cardiovascular events after adjustment for age, sex, body mass index, diabetes, and lipid levels. MASLD is characterized by insulin resistance, increased visceral adiposity, atherogenic dyslipidemia with elevated triglycerides, small dense low-density lipoprotein particles, and reduced high-density lipoprotein cholesterol. Patients exhibit systemic low-grade inflammation with elevated tumor necrosis factor-α, interleukin-6, and high-sensitivity C-reactive protein, alongside altered adipokine and hepatokine signaling, including reduced adiponectin and increased leptin, resistin, fetuin-A, and fibroblast growth factor 21. Imaging studies identify higher carotid intima–media thickness, increased coronary artery calcium scores, and early left ventricular diastolic dysfunction in patients with MASLD compared with controls. Fibrosis stage has emerged as the strongest hepatic predictor of cardiovascular outcomes. Individuals with advanced fibrosis have significantly higher rates of cardiovascular events and mortality com…
subject: Reviews
  topic: section
subject: Metabolic dysfunction-associated steatotic liver disease
  topic: keywords
subject: cardiovascular disease
  topic: keywords
subject: metabolic syndrome
  topic: keywords
subject: state-of-the-art review
  topic: keywords
creator: Aimen Shafiq
creator: Ahmed Mustafa Rashid
creator: Syed Raza Shah
creator: Nicholas W.S. Chew
creator: Wilhelm Haverkamp
rights: Copyright (c) 2026 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-10
publication date: 2026-02-10
doi: 10.4081/cardio.2026.94

Coronary artery calcium scoring. What clinicians need to know
type: item
description: Coronary artery calcium (CAC) scoring, measured by computed tomography (CT), quantifies calcified coronary plaque and reflects the burden of coronary atherosclerosis. The Agatston score, calculated based on lesion density and area, stratifies patients into risk categories: a score of 0 indicates no detectable calcification, 1-99 suggests mild plaque, 100-399 indicates moderate burden, and scores of 400 or more reflect high to extensive calcification, with scores above 1000 indicate extremely high atherosclerotic burden. CAC scoring is most beneficial in asymptomatic adults aged 40 to 75 years with borderline (5-7.5%) or intermediate (7.5-20%) 10-year ASCVD risk when uncertainty exists regarding statin initiation. The Multi-Ethnic Study of Atherosclerosis (MESA) found that a CAC score of 0 significantly reduces estimated ASCVD risk compared to pooled cohort equation (PCE) predictions, with observed event rates of approximately 1.5% for borderline-risk and 4.5% for intermediate-risk individuals, supporting reclassification into a lower-risk category. Scores of 1-99 represent modestly elevated risk and may guide prevention based on clinical judgment and patient preference. Scores from 100 to 400 reflect moderate plaque burden and support statin therapy, while high scores above 400 reflect substantial atherosclerotic burden, mandating aggressive preventive interventions. CAC testing is generally not indicated in younger, low-risk adults, as they may develop ASCVD later in life, and a score of 0 could lead to false reassurance that discourages appropriate prevention. Similarly, testing is typically unnecessary in elderly individuals with established atherosclerotic disease, as results rarely change management. It is also not recommended in those with clear statin indications, including patients with diabetes, familial hyperlipidemia, existing ASCVD, or those already on lipid-lowering treatment. Frequent CAC retesting is discouraged due to limited clinical benefit, unnece…
subject: Reviews
  topic: section
subject: Reviews
  topic: category
subject: Imaging
  topic: keywords
subject: computer tomography
  topic: keywords
subject: coronary artery disease
  topic: keywords
creator: Syeda Sundus Shah Bokharii
creator: Cristiana Vitale
creator: Eman Khan
creator: Giuseppe M.C. Rosano
creator: Laibah Arshad Khan
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-11
publication date: 2025-12-11
doi: 10.4081/cardio.2025.87

The impact of frailty on in-hospital outcomes in patients with HFrEF
type: item
description: Frailty is a marker of poor prognosis and is often undertreated and predisposed to adverse outcomes. This study aimed to determine the association between frailty and outcomes in hospitalized patients with heart failure with reduced ejection fraction (HFrEF). A retrospective cross-sectional analysis of the National Inpatient Sample (2016-2020) was conducted to evaluate hospitalizations for HFrEF. Frailty was defined as a hospital frailty risk score of ≥5. Patient demographics, comorbidities, and hospital characteristics were compared between frail and non-frail groups. Multivariable logistic regression, adjusted for confounders, was used to assess the association between frailty and in-hospital outcomes. Among 5,526,303 weighted HFrEF hospitalizations, 53% (n=2,931,329) were classified as frail. Frail patients had a median age of 74 years vs 67 years in non-frail patients. In-hospital mortality was 5.9% in frail vs 1.2% in non-frail patients (adjusted OR [aOR]: 3.8; 95% CI: 3.68-3.92). Adverse events were significantly higher in the frail group, including cardiogenic shock (5.3% vs 2.1%; aOR: 2.58), acute stroke (4.5% vs 0.8%; aOR: 6.63), acute kidney injury (47.8% vs 12.5%; aOR: 5.16), sepsis (13.4% vs 1.6%; aOR: 11.00), major bleeding (4.2% vs 2.0%; aOR: 1.90), acute pulmonary edema (0.47% vs 0.31%; aOR: 1.60), and mechanical ventilation (8.1% vs 1.7%; aOR: 5.33). Additionally, non-home discharge occurred more frequently (35.4% vs 15%; aOR: 2.77), with higher median hospital costs ($46,706 vs $34,793) and prolonged length of stay (5 vs 3 days). Frailty is independently associated with worse in-hospital outcomes in HFrEF patients, underscoring the need for targeted strategies to improve care in this high-risk population.
subject: Articles
  topic: section
subject: Articles
  topic: category
subject: Frailty
  topic: keywords
subject: heart failure with reduced ejection fraction (HFrEF)
  topic: keywords
creator: Saad Ahmed Waqas
creator: Taimor Mohammed Khan
creator: Ahmed Kamal Siddiqi
creator: Shahzad Hassan
creator: Stefan D. Anker
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-17
publication date: 2025-12-17
doi: 10.4081/cardio.2025.88

Aldosterone synthase inhibitors in cardio-renal diseases: a state-of-the-art review
type: item
description: Aldosterone plays a pivotal role in the progression of cardio-renal diseases by driving myocardial fibrosis, vascular dysfunction, and renal injury through both genomic and non-genomic mechanisms. While mineralocorticoid receptor antagonists have long served as the cornerstone of pharmacologic intervention, their use is limited by adverse effects such as hyperkalemia, gynecomastia, and incomplete suppression of aldosterone-mediated pathology. Aldosterone synthase inhibitors, a novel class of therapeutics, offer a promising alternative by targeting the enzymatic production of aldosterone at its source, thereby circumventing receptor-level limitations. This narrative review comprehensively explores the physiological role of aldosterone, critiques existing RAAS-targeted therapies, and provides an in-depth evaluation of the pharmacology, efficacy, and safety of emerging ASIs including baxdrostat, lorundrostat, and osilodrostat. Evidence from recent clinical trials such as BrigHTN, HALO, Target-HTN, and FIONE is synthesized to assess their clinical potential. In addition, the review highlights novel mechanistic frontiers including the role of ASIs in overcoming aldosterone escape, attenuating cardio-renal fibrosis, modulating neurohormonal dysregulation, and enabling precision therapy through pharmacogenomic stratification. Future directions emphasize drug design innovations such as adrenal-specific prodrugs and nanoparticle-based formulations. Overall, ASIs represent a mechanistically robust and clinically promising advancement in the treatment of heart failure, chronic kidney disease, and primary aldosteronism. Their integration into multidrug regimens and personalized treatment frameworks may redefine the therapeutic landscape of cardio-renal-metabolic disease.
subject: Reviews
  topic: section
subject: Reviews
  topic: category
subject: Aldosterone synthase inhibitors
  topic: keywords
subject: mineralocorticoid receptor
  topic: keywords
subject: cardio-renal disease
  topic: keywords
subject: hypertension
  topic: keywords
subject: aldosterone pathophysiology
  topic: keywords
subject: renin-angiotensin-aldosterone system
  topic: keywords
creator: Muhammad Hamza Dawood
creator: Muhammad Shahzeb Khan
creator: Ahmed Mustafa Rashid
creator: Wilhelm Haverkamp
rights: Copyright (c) 2026 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-31
publication date: 2025-12-31
doi: 10.4081/cardio.2025.91

Effect of metformin and empagliflozin on myocardial function in insulin-resistant patients with heart failure: rationale and design of the METRIS-HF-DZHK18 Trial
type: item
description: Impaired energy metabolism contributed to clinical severity, disease progression and to outcome in heart failure (HF). Insulin sensitivity (IS) is a key metabolic factor in the control of energy substrate utilisation and energy efficiency in cardiac and skeletal muscle. Impaired IS, or insulin resistance, is a common finding in HF and has been shown to predict morbidity and mortality in patients with heart failure with reduced and mildly reduced ejection fraction (HFrEF, HFmrEF). Despite its pathophysiologic relevance, IS has not been explored as a therapeutic target in HF. The objective of the METRIS-HF trial is to evaluate the effect of the insulin sensitizer metformin on top of standard care on myocardial contractility and functional capacity in insulin-resistant patients with HFrEF and HFmrEF in comparison to empagliflozin and placebo. METRIS-HF is an investigator initiated, multicentre, randomized, double-blind, placebo-controlled, double-dummy trial to enrol HF patients with reduced ejection fraction and insulin resistance into three parallel treatment arms in a 1:1:1 ratio to receive metformin 2x1000 daily), empagliflozin (1x10 mg/day), or double placebo, on top of standard heart failure therapy. The intervention lasts 24 weeks, followed by a 52-week follow-up period. The primary endpoint is the change in left ventricular global longitudinal strain (GLS) at 24 weeks. Key secondary endpoints include measurements of functional and symptomatic status such as 6-minute walking distance, NHYA functional class, patient global assessment (PGA), and Quality of life (EQ5D). Exploratory endpoints include metabolic, inflammatory, functional, and imaging-based biomarkers. Safety is assessed by adverse and serious adverse events throughout the trial. The METRIS-HF trial will investigate the effect of metabolic treatments to improve insulin sensitivity in patients with HFrEF and HFmrEF to provide mechanistic insights into efficacy of metabolic interventions in heart failure…
subject: Articles
  topic: section
subject: Articles
  topic: category
subject: Heart failure
  topic: keywords
subject: insulin resistance
  topic: keywords
subject: metformin
  topic: keywords
subject: empagliflozin
  topic: keywords
subject: global longitudinal strain
  topic: keywords
subject: randomized clinical trial
  topic: keywords
creator: Wolfram Doehner
creator: Tim Friede
creator: Frank Edelmann
creator: Ulf Landmesser
creator: Sebastian Winkler
creator: Burkert Pieske
creator: Fabian Knebel
creator: Sebastian Kelle
creator: Diethelm Tschöpe
creator: Antje Meyer
creator: Nadja Jauert
creator: Marius Placzek
creator: Jeanette Schulz-Menger
creator: Stephan von Haehling
creator: Stefan D. Anker
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-31
publication date: 2025-12-31
doi: 10.4081/cardio.2025.89

Aortic valve replacement in asymptomatic severe aortic stenosis. A focused review
type: item
description: Asymptomatic severe aortic stenosis (AS) has traditionally been managed with watchful waiting because of low annual sudden death rates (<1%) and concerns regarding procedural risk. Emerging randomized data indicate that irreversible myocardial injury may occur before symptom onset and that early aortic valve replacement (AVR) may improve outcomes. This review summarizes evidence from contemporary randomized controlled trials evaluating early surgical AVR (SAVR) or transcatheter AVR (TAVR) vs conservative management or surveillance in asymptomatic patients with severe AS and preserved left ventricular ejection fraction (LVEF). The RECOVERY trial randomized 145 asymptomatic patients with very severe AS (mean age 64 years) to early SAVR or conservative care. Over a median follow-up of 6.2 years, all-cause mortality occurred in 1% of the early surgery group vs 15% with conservative management (hazard ratio [HR] 0.09; 95% CI 0.01-0.67; p=0.003). The AVATAR trial included 157 asymptomatic patients with severe AS, preserved LVEF, and negative exercise testing (mean age approximately 67 years). Over a median follow-up of 32 months, the composite endpoint of all-cause death, myocardial infarction, stroke, or heart failure hospitalization occurred in 16.6% of patients assigned to early surgery compared with 32.9% in the conservative group (HR 0.46; 95% CI 0.23-0.90; p=0.02). The EARLY TAVR trial randomized 901 asymptomatic patients with severe AS and preserved LVEF to TAVR or clinical surveillance (mean age 75.8 years). After a median follow-up of 3.8 years, the primary composite outcome of death, stroke, or unplanned cardiovascular hospitalization occurred in 26.8% of the TAVR group versus 45.3% of the surveillance group (HR 0.50; 95% CI 0.40-0.63; p<0.001). Cardiovascular hospitalizations occurred in 20.9% vs 41.7%, all-cause mortality in 8.4% vs 9.2%, and stroke in 4.2% vs 6.7%, with no excess procedural complications in the early TAVR group. Randomized evidence demonstrat…
subject: Reviews
  topic: section
subject: Reviews
  topic: category
subject: Aortic stenosis
  topic: keywords
subject: aortic valve replacement
  topic: keywords
subject: watchful waiting
  topic: keywords
creator: Aimen Shafiq
creator: Rohan Dev Trehan
creator: Mitja Lainscak
creator: Sanjeev Trehan
rights: Copyright (c) 2026 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-31
publication date: 2025-12-31
doi: 10.4081/cardio.2025.93

iCARDIO Alliance Global Implementation Guidelines for the Management of Obesity 2025 - Focus on prevention and treatment of cardiometabolic disease
type: item
description: There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasize the incorporation of novel therapies, while integrating standards of care with the most up-to-date evidence to enable clinicians to optimize obesity management. Context-specific recommendations tailored to individual patient needs are highlighted, providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged, and – most importantly – also provide recommendations on several issues where resource limitations may put constraints on the care provided to patients living with obesity. Such “economic adjustment” recommendations aim to guide situations when “Resources are somewhat limited” or when “Resources are severely limited”. Hence, this document presents a comprehensive update to obesity management guidelines, thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, and invasive management of this significant global health challenge that is applicable to the needs of healthcare around the globe.
subject: Guidelines
  topic: section
subject: Guidelines
  topic: category
subject: Guidelines
  topic: keywords
subject: obesity
  topic: keywords
subject: cardiometabolic disease
  topic: keywords
subject: iCARDIO Alliance
  topic: keywords
creator: Stefan D. Anker
creator: Linong Ji
creator: Tammy Kindel
creator: Andrew J.S. Coats
creator: Dike Ojji
creator: Adriana Puente Barragán
creator: Peter Rossing
creator: Shelley Zieroth
creator: Shaaf Ahmad
creator: Shariq Usman
creator: Geeta Appannah
creator: Alison L. Bailey
creator: Ahmed Bennis
creator: Andrea Brandao
creator: Javed Butler
creator: Melanie J. Davies
creator: Lubomira Fabryova
creator: Yuanlin Guo
creator: Hidetaka Itoh
creator: Uday M. Jadhav
creator: Carel W. Le Roux
creator: Fausto J. Pinto
creator: Julio Rosenstock
creator: Banshi Saboo
creator: Hani Sabbour
creator: Mangesh Tiwaskar
creator: Karol E. Watson
creator: Kwang Wei Tham
creator: Fernando Stuardo Wyss Quintana
creator: Walter P. Abhayaratna
creator: William T. Abraham
creator: Wael Al Mahmeed
creator: Alessia Argirò
creator: John J. Atherton
creator: Danielle Belardo
creator: Raquel Campuzano Ruiz
creator: Nandini Chatterjee
creator: Vijay Chopra
creator: Marc-André Cornier
creator: Sarah Davies
creator: Clemencia de Rueda Panadero
creator: Anastase Dzudie
creator: Ty J. Gluckman
creator: Muhammad Shahzeb Khan
creator: Kamlesh Khunti
creator: Yuri Lopatin
creator: Zhiyi Ma
creator: Okechukwu S. Ogah
creator: Abraham Oomman
creator: Emilio S. Peralta Lopez
creator: Ping Li
creator: Paul Poirier
creator: Julie Redfern
creator: Giuseppe M.C. Rosano
creator: Donna Ryan
creator: Amit Saraf
creator: Sameh Shaheen
creator: Subodh Verma
creator: Stephan von Haehling
creator: Yuhui Zhang
creator: Martha Gulati
creator: Naveed Sattar
creator: José Luis Zamorano
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
doi: 10.4081/cardio.2025.86

Frequency of low-density-lipoprotein-cholesterol measurement and risk of major adverse cardiovascular outcomes: a 5-million-person nationwide cohort study
type: item
description: Cardiovascular disease (CVD) is a leading cause of mortality globally and in the UK, with significant efforts focused on early risk identification and prevention. Elevated low-density lipoprotein cholesterol (LDL-C) is a key modifiable risk factor for cardiovascular disease (CVD), yet the impact of LDL-C monitoring frequency on major adverse cardiovascular events (MACE) remains unclear. This study evaluated the relationship between LDL-C measurement frequency and the risk of MACE in a large, nationwide cohort. A retrospective cohort study using anonymised electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum, linked to hospitalisation, social deprivation, and mortality data. The cohort included individuals registered for at least one year with at least one recorded low-density LDL-C measurement between 1 January 2000 and 31 December 2022. The primary outcome was MACE, defined as a composite of non-fatal coronary heart disease, non-fatal stroke, or cardiovascular death. Multivariable Cox proportional hazards models and Kaplan-Meier survival plot were used to estimate the incidence and hazard ratios (HRs) by LDL-C monitoring frequency. The study cohort comprised 5,133,574 individuals, with 2,733,144 (53.2%) being women. The median follow-up duration was 3.31 years (IQR: 7.39-12.11). Among the 5,133,574 individuals, the incidence of MACE declined with more frequent LDL-C monitoring, from 1937.0 (95% CI: 1928.2-1945.8) events per 100,000 person-years (one measurement) to 1615.4 (95% CI: 1605.8-1625.0), 1484.6 (95% CI: 1473.7-1495.6), and 1204.9 (95% CI: 1200.1-1209.6) for those with two, three, and four or more measurements, respectively. Compared to individuals with one LDL-C measurement, the adjusted HRs for MACE were 0.703 (95% CI: 0.698-0.709), for two measurements, 0.570 (95% CI: 0.565-0.575) for three, and 0.312 (95% CI: 0.310-0.314) for four or more. The Kaplan-Meier curve demonstrated improved event-free survival with increased LDL-…
subject: Articles
  topic: section
subject: Articles
  topic: category
subject: Low-density lipoprotein cholesterol
  topic: keywords
subject: MACE
  topic: keywords
subject: cardiovascular disease
  topic: keywords
subject: cohort data
  topic: keywords
creator: Denis M. Ngina
creator: Wolfram Doehner
creator: George Ntaios
creator: Yvonne Nartey
creator: Ralph K. Akyea
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
doi: 10.4081/cardio.2025.85

Is the obesity paradox present in left ventricular assist device recipients? A BMI-based analysis
type: item
description: While body mass index (BMI) is a known determinant of cardiovascular outcomes, its impact on patients undergoing left ventricular assist device (LVAD) implantation remains unclear. This study aimed to evaluate the association between BMI and in-hospital outcomes in LVAD recipients. We conducted a retrospective, cross-sectional analysis using the National Inpatient Sample (2016-2020), identifying adult hospitalizations for LVAD implantation. Patients were categorized into six BMI groups. Outcomes assessed included in-hospital mortality, acute stroke, pump thrombosis, LVAD infection, length of stay (LOS), and hospital costs. Multivariable logistic regression adjusted for demographic, clinical, and hospital-level confounders, to estimate adjusted odds ratios (ORs) and beta (β) coefficients. Among 25,250 weighted admissions, 29.3% were females, with a median age of 63 years (IQR: 52-71). Class III obesity (BMI ≥40 kg/m2) accounted for the largest proportion (32.1%). The highest mortality rate was observed in the underweight group (6.7%), and class III obesity (5.8%) groups, while the lowest rate was noted in the class II obesity group (2.5%). Overall, a reverse J-shaped relationship between BMI and in-hospital mortality was observed. Compared to normal BMI, Class I (OR: 2.46; p=0.038), Class II (OR: 3.73; p=0.017), and Class III obesity (OR: 6.80; p<0.001) were significantly associated with increased odds of in-hospital mortality. Class III obesity was also associated with significantly prolonged LOS (β: 7.07 days; p=0.002) and higher hospital costs (β: $208,791.5; p=0.001). Overweight patients (BMI 25-29.9 kg/m2) had significantly lower odds of acute stroke (OR: 0.40; p=0.030), while no BMI group showed a significant association with pump thrombosis and LVAD infection. Higher BMI, particularly Class III obesity, is independently associated with increased mortality, length of stay, and hospital costs in LVAD recipients. These findings challenge the obesity paradox and u…
subject: Articles
  topic: section
subject: Articles
  topic: category
subject: Chronic HF treatment
  topic: keywords
subject: ventricular assist devices
  topic: keywords
subject: obesity
  topic: keywords
creator: Saad Ahmed Waqas
creator: Hibah Siddiqui
creator: Faouzi Kallel
creator: Shahzad Hassan
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
doi: 10.4081/cardio.2025.84

Demographic and regional trends of heart failure and cachexia-related mortality among older adults in the United States, from 1999 to 2020
type: item
description: Cachexia is a debilitating yet under-recognized condition, particularly among the elderly population. It has been shown that patients with heart failure (HF) often have cachexia, leading to worsening mortality rates. There is limited research on mortality trends and demographic disparities in terms of cachexia. CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging ONline Data for Epidemiologic Research) database was used, where HF and cachexia were listed as either contributory or underlying causes of death in adults >65 years from 1999-2020. Age-adjusted mortality rates (AAMRs) and annual percent changes (APC) were calculated and stratified by year, sex, race/ethnicity, and region. No change in mortality was seen due to HF + cachexia from 2004-2020 (APC -2.1%; 95% CI, -3.2 to 0.6). Almost half of the deaths (47%) occurred within nursing homes. Notably, White adults had a higher mortality than Black/ African American adults (23.8; 95% CI, 23.4 to 24.1 vs 18.4; 95% CI, 17.4 to 19.4). Mortality rates were also higher in rural areas than urban areas (27.9; 95% CI, 27.1 to 28.7 vs 22.1; 95% CI, 21.8 to 22.4). States in the top 90th percentile, including Idaho, Utah, Vermont, South Carolina, Alaska and New Hampshire, had 5-fold higher mortality than states in the lower 10th percentile. No change in mortality was seen due to HF and cachexia-related mortality in the last decade, with substantial racial and regional disparities. Targeted interventions are needed to curb these mortality trends.
subject: Articles
  topic: section
subject: Articles
  topic: category
subject: Chronic heart failure
  topic: keywords
subject: CVD in elderly
  topic: keywords
subject: cachexia
  topic: keywords
creator: Ishaque Hameed
creator: Muhammad Nashit
creator: Zahra Quettawala Mufaddal
creator: Syed Sarmad Javaid
creator: Muhammad Hanif
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-19
publication date: 2025-09-19
doi: 10.4081/cardio.2025.83

Iron supplementation in heart failure and iron deficiency: does it help?
type: item
description: Iron deficiency (ID) is present in 30-80% of patients with heart failure (HF) and is associated with poor prognosis. Intravenous (IV) iron therapy has been evaluated in several randomized controlled trials and consistently shown to improve functional outcomes. In FAIR-HF, 50% of patients receiving FCM achieved NYHA class improvement to I or II by 24 weeks vs 30% with placebo. CONFIRM-HF showed a significant 33-meter increase in 6-minute walk distance (6MWD) at 24 weeks (p=0.002), alongside improvements in NYHA class. The recent trial FAIR-HF2 demonstrated smaller but significant gains in 6MWD (+10.7 m) and global well-being at 12 months. Cardiovascular outcomes have been more variable. AFFIRM-AHF showed a 26% reduction in total HF hospitalizations (HR 0.74; 95% CI, 0.58-0.94) with IV iron vs placebo. Although the composite of cardiovascular death or first HF hospitalization was narrowly non-significant (HR 0.79; 95% CI, 0.62-1.01), the effect may still be clinically meaningful. IRONMAN, using ferric derisomaltose vs placebo, was neutral for the primary endpoint of HF hospitalization and cardiovascular death (RR 0.82; 95% CI, 0.66-1.02) but showed benefit in a COVID-censored sensitivity analysis (RR 0.76; 95% CI, 0.58-1.00). In HEART-FID, involving over 3,000 patients, no benefit was also seen with IV iron for the composite of death, HF hospitalization, and 6MWD at 99% CI, however was significant at 95% CI. FAIR-HF2 showed a 21% reduction in the primary endpoint (HR 0.79; 95% CI 0.61-1.02) with IV iron, which did not meet statistical significance, but a prespecified 12-month sensitivity analysis demonstrated a 29% reduction in first cardiovascular death or HF hospitalization (0.71 (95% CI, 0.53-0.94) and a 35% reduction in total HF hospitalizations (RR 0.65; 95% CI, 0.47-0.90). The most recent meta-analysis (n>7,000) showed a 28% reduction of composite of cardiovascular death and HF hospitalizations at 1 year (RR 0.72; 95% CI, 0.55-0.89) with IV iron. Benefits were s…
subject: Reviews
  topic: section
subject: Reviews
  topic: category
subject: Iron deficiency
  topic: keywords
subject: intravenous iron therapy
  topic: keywords
subject: clinical trials
  topic: keywords
subject: heart failure
  topic: keywords
creator: Laibah Arshad Khan
creator: Syed Sarmad Javaid
creator: Javed Butler
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
doi: 10.4081/cardio.2025.82

Advancements in transcatheter tricuspid valve repair and replacement: a state-of-the-art review with echocardiographic outcomes
type: item
description: Tricuspid regurgitation (TR) affects over 1.6 million individuals in the United States, with a one-year mortality rate of 36.1% and a five-year survival below 30%. Despite its prevalence being comparable to mitral regurgitation and aortic stenosis, TR remains understudied and inadequately managed. The underlying causes of TR vary, with primary TR stemming from structural abnormalities of the tricuspid valve, including damage caused by infectious endocarditis, rheumatic heart disease, congenital anomalies, or trauma, while secondary TR arises from right ventricular pressure and volume overload due to conditions such as heart failure (HF), atrial fibrillation, and pulmonary hypertension (PH). As TR progresses, it leads to higher hospitalization rates and imposes a significant healthcare burden, particularly in patients with advanced HF and PH. Medical therapy provides only symptomatic relief, while surgical intervention, carries high in-hospital mortality and complication risks. Given these challenges, transcatheter tricuspid valve interventions (TTVI) have emerged as promising alternatives, offering both transcatheter tricuspid valve repair (TTVr) and replacement (TTVR) strategies. TTVr devices such as TriClip, PASCAL, and Cardioband enhance leaflet coaptation or reduce annular dilation while preserving the native valve, resulting in lower procedural risks and faster recovery. Meanwhile, TTVR devices such as Evoque, TricValve, and LUX-Valve provide a definitive solution for patients with severe annular dilation, large coaptation gaps, or significant leaflet tethering. The growing population of underserved TR patients and the favourable outcomes of transcatheter therapies have accelerated advancements in device development and expanded treatment options. This review explores the latest advancements in TTVr and TVVR strategies, highlighting their clinical significance and echocardiographic outcomes based on recent data. Graphical Abstract
subject: Reviews
  topic: section
subject: Reviews
  topic: category
subject: Tricuspid regurgitation
  topic: keywords
subject: tricuspid valve
  topic: keywords
subject: transcatheter tricuspid valve interventions
  topic: keywords
creator: Asad Gul Rao
creator: Syed Sarmad Javaid
creator: Ahmed Mustafa Rashid
creator: Fawaz Alenezi
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-15
publication date: 2025-09-15
doi: 10.4081/cardio.2025.81

Lipoprotein(a): what clinicians need to know
type: item
description: Lipoprotein(a) [Lp(a)] is a plasma particle structurally similar to LDL, distinguished by the presence of apolipoprotein(a), and has evolved from plasminogen. Lp(a) concentration is 90% genetically determined and largely stable throughout life. Black individuals exhibit the highest Lp(a) levels, followed by South Asians, Whites, Hispanics, and East Asians, with a 2- to 4-fold median difference across ancestral groups. Approximately 1.5 billion people worldwide (~20% of the population) have elevated Lp(a) levels (>125 nmol/L or >50 mg/dL). Notably, women experience 17% higher levels than men post-menopause. Mendelian randomization studies have established Lp(a) as a strong cardiovascular disease (CVD) risk factor, implicated in coronary artery disease, peripheral artery disease (PAD), ischemic stroke, heart failure, and aortic stenosis. Risk increases linearly with Lp(a) levels, with concentrations >90 mg/dL (>190 nmol/L) associated with a 1.6-fold higher risk of ischemic stroke, 1.7-fold for heart failure, 2-fold for PAD, and 3-fold for aortic stenosis and myocardial infarction. Lp(a) levels between 130–391 mg/dL (280–849 nmol/L) confer atherosclerotic CVD risk equivalent to familial hypercholesterolemia. Universal screening of once Lp(a) test is now recommended for all adults in guidelines across the US, Europe and Canada. However, Lp(a) testing is severely underutilized with studies showing 0.3% testing frequency amongst 5.5 million US patients. Even in high-risk patients with established ASCVD, only 13.9% are tested for Lp(a). Existing treatment options for elevated Lp(a) include proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and lipoprotein apheresis. Emerging therapies include antisense oligonucleotides such as pelacarsen, small-interfering RNA such as zerlasiran, olpasiran, and lepodisiran, and oral agents such as muvalaplin. These medications have shown a significant reduction in plasma levels up to 80% (pelacarsen), 96.9% (olpasiran), 97% (…
subject: Facts & Numbers Editorials
  topic: section
subject: Editorials
  topic: category
subject: Lipoprotein(a)
  topic: keywords
subject: cardiovascular disease
  topic: keywords
subject: heart failure
  topic: keywords
creator: Laibah Arshad Khan
creator: Muhammad Hanif
creator: Ahmed Mustafa Rashid
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-01
publication date: 2025-09-01
doi: 10.4081/cardio.2025.80

Optimized heart failure therapy in patients with very advanced cancer in palliative care: dosing strategies from the EMPATICC trial
type: item
description: Cardiac wasting occurs in patients with end-stage cancer, leading to the development of heart failure (HF)-like symptoms characterized by dyspnea, reduced physical function, and diminished quality of life. The EMPATICC (EMPower the heArt of patients with TermInal Cancer using Cardiac medicines) is a randomized controlled trial designed to evaluate the impact of optimized HF therapy in patients with very advanced cancer in palliative care. Given the susceptibility to adverse drug events in this vulnerable population, the trial employed a protocol-driven approach for the initiation and titration of each medication. EMPATICC is a multi-center, randomized, double-blind, controlled, proof-of-concept trial that enrolled 93 patients with stage IV solid tumors (per Union for International Cancer Control [UICC]), under palliative care, with clinical features indicating cardiovascular risk and functional limitation. Participants were randomized 1:1 to receive optimized HF therapy, including sacubitril/valsartan, empagliflozin, ivabradine, and ferric carboxymaltose (FCM), or 1-4 placebo therapies on top of usual care. All trial medications (or placebo) that were available in tablet form were provided in pre-packed containers to support blinding. Blue placebo tablets were used for empagliflozin, white tablets for sacubitril/valsartan, and pink tablets for irbesartan. Blinded staff members did not have access to individual tablet packaging or knowledge of color allocations. Additionally, the meaning of the color-coded tablets was not disclosed to the blind staff members throughout the trial. Dosing protocols were guided by predefined criteria, including blood pressure, renal function, heart rate, hemoglobin, and body weight, and they were implemented by unblinded staff. Algorithms accounted for prior RAAS inhibitor exposure when initiating sacubitril/valsartan; ensured hemodynamic stability and sinus rhythm for ivabradine; assessed renal reserve when starting empagliflozin to su…
subject: Articles
  topic: section
subject: Articles
  topic: category
subject: Heart failure therapy
  topic: keywords
subject: end-stage cancer
  topic: keywords
subject: cardiac wasting
  topic: keywords
subject: clinical trial
  topic: keywords
creator: Markus S. Anker
creator: Sven Bercker
creator: Ulrich Laufs
creator: Michael Böhm
creator: Bela Merkely
creator: Monika Diek
creator: Tim Heise
creator: Martin Hellmich
creator: Marius Placzek
creator: Tim Friede
creator: Stefan D. Anker
creator: Lorenz Lehmann
creator: Ulf Landmesser
creator: Dominik P. Modest
creator: Muhammad Shahzeb Khan
creator: Amir A. Mahabadi
creator: Matthias Totzeck
creator: Mitra Tewes
creator: Muhammad Sameer Arshad
creator: Raluca Mincu
creator: Javed Butler
creator: Ulrich Keller
creator: Johann Ahn
creator: Lars Bullinger
creator: Tienush Rassaf
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-08-20
publication date: 2025-08-20
doi: 10.4081/cardio.2025.78

Self-administered intranasal etripamil: a breakthrough in PSVT first-line treatment
type: item
description: Dear Editor, PSVT, AVRT, and AVNRT are types of arrhythmia resulting from disruptions in the heart's electrical activity, originating from the sinoatrial node and propagating via the atria to the AV node, causing sudden symptoms like palpitations and dyspnea...
subject: Letters to the Editor
  topic: section
subject: Contents
  topic: category
subject: Letters
  topic: category
subject: Etripamil
  topic: keywords
subject: PSVT
  topic: keywords
subject: arrhythmia
  topic: keywords
subject: intranasal
  topic: keywords
subject: self-administered
  topic: keywords
creator: Muddassir Khalid
creator: Aqsa Asif
creator: Sara Rasheed
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-31
publication date: 2025-07-31
doi: 10.4081/cardio.2025.79

Sex-based differences in characteristics, management, and outcomes in heart failure with reduced ejection fraction
type: item
description: Heart failure with reduced ejection fraction (HFrEF) exhibits significant sex-based differences in clinical presentation, management, and outcomes. This study aimed to evaluate these differences using data from the Swedish Heart Failure Registry (SwedeHF). We analyzed 65,605 patients with HFrEF (EF <40%) from the SwedeHF registry. Baseline characteristics, treatment patterns, and outcomes were compared between females and males. Multivariable logistic regression was used to evaluate predictors of treatment use. Cox proportional hazards models were used to assess the risk of cardiovascular mortality and heart failure (HF) hospitalization, adjusting for demographic and clinical variables. Odds ratios (OR) were reported for treatment use, and hazard ratios (HR) were used for outcome analyses. Females (29.0%) were older than males and had a higher prevalence of hypertension (61.3% vs 49.8%) and valvular disease (17.2% vs 11.1%), while males had a higher prevalence of ischemic heart disease (70.5% vs 40.1%) and diabetes (31.6% vs 28.4%). Males were less likely to receive beta-blockers (OR: 0.76, 95% CI 0.71-0.81), and more likely to receive sodium-glucose co-transporter-2 inhibitors (OR: 1.27, 95% CI 1.17-1.38) and implantable cardioverter-defibrillators/cardiac resynchronization therapy (OR: 1.41, 95% CI 1.30-1.52). During a median follow-up of 2.1 years, males had a higher risk of the composite outcome of cardiovascular death or HF hospitalization (HR: 1.19, 95% CI 1.16-1.22), cardiovascular death (HR: 1.33, 95% CI 1.28-1.37), and HF hospitalization (HR: 1.16, 95% CI 1.12-1.19). In this large cohort of patients with HFrEF, males had worse outcomes across all major cardiovascular endpoints. These findings highlight the need for tailored strategies to address sex-based disparities in HF management and improve outcomes for both sexes.
subject: Articles
  topic: section
subject: Articles
  topic: category
subject: Heart failure
  topic: keywords
subject: reduced ejection fraction
  topic: keywords
subject: sex differences
  topic: keywords
subject: artificial intelligence
  topic: keywords
subject: large-language model
  topic: keywords
creator: Christian Basile
creator: Stefan D. Anker
creator: Gianluigi Savarese
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
doi: 10.4081/cardio.2025.73

Large language models to write scientific manuscripts: to be considered but not trusted
type: item
description: Large language models (LLMs) are rapidly permeating scientific writing. Using ChatGPT 4o and real-world data from the Swedish Heart Failure Registry, we explored both the promise and the pitfalls of LLM-assisted manuscript drafting. We demonstrate that, with strict human oversight, LLMs may accelerate text generation but still hallucinate, frequently misinterpret effect directions, and are often unable to access other manuscripts for direct references. Until these limitations are addressed, LLMs should complement, rather than replace, domain experts in scientific publishing.
subject: Editorials
  topic: section
subject: Editorials
  topic: category
subject: Artificial intelligence
  topic: keywords
subject: machine learning
  topic: keywords
subject: large language models
  topic: keywords
subject: writing tools
  topic: keywords
subject: heart failure
  topic: keywords
creator: Christian Basile
creator: Stefan D. Anker
creator: Gianluigi Savarese
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
doi: 10.4081/cardio.2025.74

Applicability of obesity clinical practice guidelines in low- and middle-income countries
type: item
description: Obesity is a chronic disease and its impact on individuals and society is a major global health problem, with a high prevalence across all socio-economic strata. Some specialty societies include obesity management related recommendations in clinical practice guidelines, but relatively few guidelines are specifically designed to fully address its diagnosis and management. We sought to understand clinicians' use of obesity clinical practice guidelines in their practice, the perceived deficiencies and implementation barriers, and differences between those practicing in high-income countries (HIC) and those in low-/middle-income countries (LMIC). An email survey of physicians in the Translational Medicine Academy database was offered from August 26 to December 26, 2024 to inquire about participants' demographic information, experience, and views of obesity guidelines as related to their practice. Of 1,412 participating clinicians from 129 countries, 741 partially completed, and an additional 671 fully completed the survey: 281 practiced in HIC; 1,130 in LMIC. Obesity was recognized as a disease (93.5% of respondents) as was its impact on other disorders: cardiovascular disease ranked as the most important, and hepatic disorders the least, with no differences between HIC and LMIC. Only 13.1% regarded the guidelines as equally applicable across different economic strata and geography, and just 29% thought the guidelines to be applicable in their country, with no difference between HIC and LMIC. The most frequently indicated reason given for hindering implementation of obesity guidelines was that they were primarily relevant for HIC; the most common local factor hindering implementation was cost, with no difference in views between HIC and LMIC. There was broad agreement (83.4%) for the importance/need for specific recommendations for patients of differing socio-economic status, with no difference between HIC (79.4%) and LMIC (84.3%; p=0.191), and for guideline authors to …
subject: Articles
  topic: section
subject: Articles
  topic: category
subject: Obesity
  topic: keywords
subject: clinical practice guidelines
  topic: keywords
subject: survey
  topic: keywords
subject: implementation
  topic: keywords
subject: obstacles
  topic: keywords
subject: low-, middle-, and high-income countries
  topic: keywords
creator: Shelley Zieroth
creator: Fausto Pinto
creator: Stefan D. Anker
creator: William T. Abraham
creator: John J. Atherton
creator: Javed Butler
creator: Vijay Chopra
creator: Andrew J.S. Coats
creator: Martha Gulati
creator: Tammy L. Kindel
creator: José Luis Zamorano
creator: Yuhui Zhang
creator: Linong Ji
creator: Yann Colardelle
creator: Richard B. Weiskopf
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
doi: 10.4081/cardio.2025.77

Safety and efficacy of left atrial appendage closure in cancer versus non-cancer patients: a systematic review and meta-analysis
type: item
description: There is an ongoing debate regarding the safety and efficacy of left atrial appendage occlusion (LAAO) for atrial fibrillation in patients with cancer. We searched PubMed and Scopus from the database's inception until November 2024 and included studies comparing cancer patients with non-cancer patients undergoing left atrial appendage closure for atrial fibrillation. Our primary outcome was short-term mortality. Secondary outcomes were ischemic stroke, major bleeding, device complications, and pericardial complications. For the dichotomous outcomes, risk ratios (RR) were used, whereas generic inverse variance (GIV) was used to pool the RRs and corresponding 95% confidence interval (95% CI). A random effects model was used to evaluate all the outcomes. Our analysis showed a significantly higher rate of short-term mortality in patients with cancer as compared to non-cancer patients (RR=2.07; 95% CI [1.12 to 3.84]; p=0.02). From secondary outcomes, pericardial complications showed a significantly higher risk in cancer patients (RR: 2.17, 95% CI [1.51, 3.12]; p<0.0001). Meanwhile, other secondary outcomes were found to be insignificant. LAAO in cancer patients was significantly associated with higher short-term mortality and pericardial complications.
subject: Reviews
  topic: section
subject: Reviews
  topic: category
creator: Muhammad Ahmed
creator: Fatima Muskan
creator: Mohsin Zaheer
creator: Manesh Kumar
creator: Sawera Gul
creator: Abdul Hadi Ansari
creator: Muhammad Sameer Jamal
creator: Muhammad Sohaib Asghar
creator: M. Chadi Alraies
creator: Shiny Teja Kolli
creator: Praveen Kumar Komminni
creator: Priya Hotwani
creator: Vishal Reddy Bejugam
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
doi: 10.4081/cardio.2025.72

iCARDIO Alliance Global Implementation Guidelines on Heart Failure 2025
type: item
description: Inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices as well as practical and political issues restrict the global applicability of currently available guidelines. There is a need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our iCARDIO Alliance Global Implementation Guidelines emphasize the incorporation of novel therapies, while integrating standard of care with the most uptodate evidence to enable clinicians to optimize patient care. This document is about heart failure (HF), including acute and chronic heart failure, heart failure with reduced ejection fraction and heart failure with preserved ejection fraction as well as cardiomyopathies. Context-specific recommendations tailored to individual patient needs are highlighted providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged. Most importantly these guidelines also provide recommendations on a number of issues where resource limitations may put constraints on the care provided to HF patients. Such “economic adjustment” recommendations aim to provide guidance for situations when “Resources are somewhat limited” or when “Resources are severely limited”. Hence, this document presents not only a comprehensive but also concise update to HF management guidelines thereby aiming to provide a unified strategy for the pharmacological, nonpharmacological, invasive and interventional management of this significant global health challenge that is appli…
subject: Guidelines
  topic: section
subject: Contents
  topic: category
subject: Reviews
  topic: category
subject: Guidelines
  topic: category
subject: iCARDIO Alliance
  topic: keywords
subject: guidelines
  topic: keywords
subject: heart failure
  topic: keywords
subject: chronic heart failure
  topic: keywords
subject: acute heart failure
  topic: keywords
subject: therapy.
  topic: keywords
creator: Vijay Chopra
creator: Muhammad Shahzeb Khan
creator: Magdy Abdelhamid
creator: William T. Abraham
creator: Offer Amir
creator: Stefan D. Anker
creator: John J. Atherton
creator: Fernando Bacal
creator: Ralph Stephan von Bardeleben
creator: Dulce Brito
creator: Lucrecia Maria Burgos
creator: Javed Butler
creator: Maria Rosa Costanzo
creator: Albertino Damasceno
creator: Justin A. Ezekowitz
creator: Ishaque Hameed
creator: Sivadasanpillai Harikrishnan
creator: Tiny Jaarsma
creator: Anuradha Lala
creator: Ileana L. Piña
creator: Clara Saldarriaga
creator: David Sim
creator: John R. Teerlink
creator: Nqoba Tsabedze
creator: Hiroyuki Tsutsui
creator: Jing Yu
creator: Yuhui Zhang
creator: Mohammad Zubaid
creator: Nikhil Balankhe
creator: Juan Esteban Gomez-Mesa
creator: James L. Januzzi
creator: Marvin Konstam
creator: Rhonda Monroe
creator: Elijah Ogola
creator: Vinayagam Palaniappan
creator: Mark C. Petrie
creator: Fausto J. Pinto
creator: Girish C. Rajadhyaksha
creator: Amina Rakisheva
creator: Carlos E. Ramos
creator: Victor Rossel
creator: Naoki Sato
creator: P. Christian Schulze
creator: Andrew Sindone
creator: Hadi N. Skouri
creator: Harriette G.C. Van Spall
creator: Aistė Štaraitė
creator: Lynne Warner Stevenson
creator: Kadhim Sulaiman
creator: Tzung-Dau Wang
creator: Michael Böhm
creator: Andrew J.S. Coats
creator: Shelley Zieroth
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
doi: 10.4081/cardio.2025.70

Importance of patient-reported outcomes in cardiovascular illnesses
type: item
description: Patient-reported outcomes (PROs) are increasingly recognized as pivotal tools in understanding health status, treatment impact, and quality of life (QoL) in patients, particularly those with chronic cardiovascular diseases. These standardized and validated tools capture the patient’s perspective on physical, emotional, and social health dimensions, bridging gaps often missed by clinical evaluations. Despite their growing adoption in research, the use of PROs in new drug approvals has declined, from 30% between 1997–2002 to 16.5% between 2011–2015, raising concerns about their underutilization in real-world settings. However, their role in clinical care and research continues to expand, with the proportion of clinical trials incorporating PROs increasing from 14% between 2004–2007 to 27% between 2007–2013. PRO measures (PROMs) span multiple domains, including overall health, such as EQ-5D, SF-36, and PROMIS Profile-29 to evaluate health-related quality of life (HRQoL), psychological health, evaluated by instruments like the Patient Health Questionnaire-9 (PHQ-9), specific symptoms, such as pain and fatigue, functional status, and disease-specific outcomes such as the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). The clinical impact of PROs is evident in their association with prognostic outcomes. Each 5-point decrease in the KCCQ score correlates with a 6–9% higher risk of cardiovascular death or heart failure hospitalization. Meta-analyses reveal that higher HRQoL reduces mortality risk by 37% (HR 0.633, 95% CI: 0.514–0.780). Additionally, in pre-terminal cancer patients, self-reported abilities to walk 4 meters and wash oneself independently predicted survival, hazard ratios of 0.63 (p=0.015) and 0.67 (p=0.024), respectively. Moreover, in chronic obstructive pulmonary disease, pain and discomfort predicted re-hospitalization and HRQoL predicted 180-day survival. These findings underscore the critical role of PROs in enhancing patient care, guiding therapeutic…
subject: Facts & Numbers Editorials
  topic: section
subject: Contents
  topic: category
subject: Editorials
  topic: category
subject: Heart failure
  topic: keywords
subject: patient-reported outcomes
  topic: keywords
creator: Wardah Rasool
creator: Ahmed Kamal Siddiqi
creator: Laibah Arshad Khan
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
doi: 10.4081/cardio.2025.69

Cardiac wasting in patients with advanced cancer: state of the art review
type: item
description: Cardiac wasting, a complex and understudied phenomenon, is observed in up to 40% of patients with advanced cancer, contributing to 20-30% of mortality within this cohort. This condition represents a significant determinant of impaired quality of life and increased mortality, highlighting its clinical importance. Numerous pathophysiological mechanisms have been identified in clinical and pre-clinical research as key drivers in the development and progression of cardiac wasting, including elevated circulating inflammatory cytokines, enhanced catabolic processes, hormonal dysregulation, dysfunction of the growth hormone-insulin-like growth factor I (GH-IGF-I) axis, oxidative stress, psychosocial factors, myosin heavy chain isoform switching, and, critically, cardiotoxic effects of anticancer therapies. Clinically, cardiac wasting manifests through a spectrum of symptoms and consequences, including muscle wasting, heart failure-like symptoms, impaired global longitudinal strain (GLS), and structural and functional alterations in the heart, particularly within the left ventricle. These cardiac alterations contribute to progressive cardiovascular decline. Preclinical and clinical studies have confirmed these observations across various models and patient cohorts, demonstrating significant cardiac changes, such as a 33% reduction in cardiomyocyte cross-sectional area, up to 21% decrease in left ventricular mass & 11% reduction in heart weight, and a 50% reduction in left ventricular axon length. Additionally, fibrosis in pre-clinical studies, preservation of left ventricular ejection fraction in some studies, and mild decreases in others, along with an 8.1% reduction in GLS and a 12.1% loss in left ventricular wall thickness, are observed, in conjunction with elevated circulating levels of interleukin-6 (IL-6). Given the substantial morbidity and mortality associated with cardiac wasting in advanced cancer, it is imperative to incorporate comprehensive cardiac assessment i…
subject: Reviews
  topic: section
subject: Contents
  topic: category
subject: Reviews
  topic: category
subject: populations
  topic: keywords
subject: cardio-oncology
  topic: keywords
creator: Laibah Arshad Khan
creator: Muhammad Shahzeb Khan
creator: Rania Usman Latif
creator: Markus S. Anker
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-04-16
publication date: 2025-04-16
doi: 10.4081/cardio.2025.65

Bridging the gap: integrating stress echocardiography, iFR, CFR, and FFR in the evaluation of coronary artery disease
type: item
description: Cardiac wasting, a complex and understudied phenomenon, is observed in up to 40% of patients with advanced cancer, contributing to 20-30% of mortality within this cohort. This condition represents a significant determinant of impaired quality of life and increased mortality, highlighting its clinical importance. Numerous pathophysiological mechanisms have been identified in clinical and pre-clinical research as key drivers in the development and progression of cardiac wasting, including elevated circulating inflammatory cytokines, enhanced catabolic processes, hormonal dysregulation, dysfunction of the growth hormone-insulin-like growth factor I (GH-IGF-I) axis, oxidative stress, psychosocial factors, myosin heavy chain isoform switching, and, critically, cardiotoxic effects of anticancer therapies. Clinically, cardiac wasting manifests through a spectrum of symptoms and consequences, including muscle wasting, heart failure-like symptoms, impaired global longitudinal strain (GLS), and structural and functional alterations in the heart, particularly within the left ventricle. These cardiac alterations contribute to progressive cardiovascular decline. Preclinical and clinical studies have confirmed these observations across various models and patient cohorts, demonstrating significant cardiac changes, such as a 33% reduction in cardiomyocyte cross-sectional area, up to 21% decrease in left ventricular mass and 11% reduction in heart weight, and a 50% reduction in left ventricular axon length. Additionally, fibrosis in pre-clinical studies, preservation of left ventricular ejection fraction in some studies, and mild decreases in others, along with an 8.1% reduction in GLS and a 12.1% loss in left ventricular wall thickness, are observed, in conjunction with elevated circulating levels of interleukin-6 (IL-6). Given the substantial morbidity and mortality associated with cardiac wasting in advanced cancer, it is imperative to incorporate comprehensive cardiac assessment…
subject: Articles
  topic: section
subject: Contents
  topic: category
subject: Articles
  topic: category
subject: Coronary artery disease
  topic: keywords
subject: factional flow reserve
  topic: keywords
subject: instantaneous wave-free ratio
  topic: keywords
subject: stress echocardiography
  topic: keywords
subject: coronary microvascular dysfunction
  topic: keywords
creator: Konstantinos Stamos
creator: Theodora Delaporta
creator: Antonios Delaportas
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-04-16
publication date: 2025-04-16
doi: 10.4081/cardio.2025.66

https://www.globalcardiology.info/site/article/view/64
type: item
title: Elevated endostatin is associated with hypertension treatment, elevated high sensitivity C-reactive protein, increased waist-hip ratio, and attenuated kidney function, but not with age, in a middle-aged population
description: Circulating endostatin has been linked to increased mortality, cardiovascular comorbidities, and renal impairment. However, its role as a cardiovascular risk marker in the general population remains largely unexplored. This study investigates the association between plasma endostatin and atherosclerosis, inflammation, and kidney function in a cohort of 5,026 randomly selected middle-aged individuals from the Swedish CArdioPulmonary bioImage Study (SCAPIS). Plasma levels of endostatin, C-reactive protein (CRP), HbA1c, lipids, and creatinine were analyzed, and their associations with atherosclerosis and related markers were assessed. Coronary artery atherosclerosis was evaluated using coronary computed tomography. Blood pressure, body mass index, and waist circumference were measured, and medication use for diabetes, hyperlipidemia, and hypertension was recorded. Smoking habits were also documented. The following main results were significantly associated with endostatin. Severe coronary atherosclerosis was positively associated in men. Being on hypertensive medication or not, as reported by the participants at the interview at study inclusion, was significantly associated with endostatin. Hypertensive medication increased from 12% to 26% from the lowest to the highest quartile of endostatin. Waist circumference was positively associated, where endostatin increases, on average, 0.21±SD for a 1±SD increase of waist circumference. Kidney function, measured as eGFR, was negatively associated, where endostatin decreases, on average, 0.22±SD for a 1±SD increase in eGFR. Elevated endostatin levels were associated with advanced coronary atherosclerosis in men, antihypertensive treatment, systemic inflammation (increased CRP), increased waist circumference, and impaired kidney function (lower eGFR).
subject: Articles
  topic: section
subject: Contents
  topic: category
subject: Articles
  topic: category
subject: Endostatin
  topic: keywords
subject: glomerular filtration rate
  topic: keywords
subject: cardiovascular disease
  topic: keywords
subject: atherosclerosis
  topic: keywords
creator: Anders Larsson
creator: Bertil Wegmann
creator: Toralph Ruge
creator: Joakim Alfredsson
creator: Carl Johan Östgren
creator: Tomas Lindahl
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-04-16
publication date: 2025-04-16
doi: 10.4081/cardio.2025.64

Impella vs intra-aortic balloon pump in patients with acute myocardial infarction complicated with cardiogenic shock: an updated systematic review and meta-analysis
type: item
description: Cardiogenic shock (CS) is a major cause of mortality in patients with acute myocardial infarction (AMI). Mechanical circulatory support devices like Impella and Intra-Aortic Balloon Pump (IABP) manage AMI-CS, but their comparative effectiveness remains unclear. We conducted a meta-analysis following Cochrane and PRISMA guidelines. From the database inception until March 2024, we searched databases including PubMed, Google Scholar, and the Cochrane Library for studies comparing Impella and IABP in AMI-CS patients. Risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes were calculated using a random-effects model. Nine studies involving 18,289 patients were included and the mean age of patients in the Impella group was 64.79 years, and 64.75 years in the IABP group. Short-term mortality showed no significant difference between Impella and IABP (RR: 1.13, 95% CI: 0.84-1.52, p=0.42, I²=76%). Impella was associated with higher risks of hemolysis (RR: 9.46, p=0.009), limb ischemia (RR: 3.65, p=0.003), transfusion (RR: 2.03, p< 0.0001), and acute kidney injury (RR: 1.22, p=0.04). Meta-regression indicated that peripheral arterial disease, prior PCI, and left ventricular ejection fraction were significant covariates for short-term mortality. Our meta-analysis found no significant difference in short-term mortality between Impella and IABP in AMI-CS patients. In contrast, Impella is associated with higher risks of hemolysis, limb ischemia, transfusion needs, and acute kidney injury. Peripheral arterial disease, prior PCI, and lower LVEF were significantly associated with short-term mortality, with PAD and prior PCI increasing risk, while higher LVEF demonstrated a protective effect.
subject: Reviews
  topic: section
subject: Contents
  topic: category
subject: Reviews
  topic: category
subject: Impella
  topic: keywords
subject: intra-aortic balloon pump
  topic: keywords
subject: cardiogenic shock
  topic: keywords
subject: meta-analysis
  topic: keywords
creator: Muhammad Ahmed
creator: Serish Bano
creator: Mutahira Asif
creator: F.N.U. Sidra
creator: Meva Ram
creator: Shahida Bibi
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-04-16
publication date: 2025-04-16
doi: 10.4081/cardio.2025.61

Dyslipidemia and stroke-related mortality in the United States: a nationwide analysis for 2010-2020
type: item
description: Dyslipidemias are a significant risk factor for stroke. Still, there is limited data on mortality trends where both dyslipidemia and stroke are either contributing or underlying causes of death among adults aged ≥ 25 years. We aimed to evaluate the demographic, regional, and temporal trends in dyslipidemia and stroke-related mortality among adults from 2010 to 2020. The CDC WONDER mortality data were utilized to identify deaths with both dyslipidemia and stroke as either underlying or contributing causes of death in adults aged ≥ 25 years. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC) were calculated and further categorized by year, sex, race/ethnicity, region, and urban-rural status. Joinpoint regression was used to determine changes in trends over time. Between 2010 and 2020, a total of 106,813 dyslipidemia and stroke-related deaths occurred among adults aged ≥ 25 years, with the most in medical facilities (35.7%), at home (27.7%), or in nursing/long-term care facilities (26.9%). The AAMR increased from 3.47 in 2010 to 5.47 in 2020, stable through 2018 (APC 1.6 [95% CI, −0.4 to 2.7]) then rising sharply (APC 15.1 [95% CI, 7.5 to 19.5]). Men had higher mortality than women (AAMR: 4.44 vs. 3.66). The Non-Hispanic (NH) Black or African American population had the highest overall AAMR (4.97), followed by the NH White population (3.99), the NH American Indian or Alaska Native population (3.87), the NH Asian or Pacific Islander population (3.59), and the Hispanic or Latino population (3.25) Vermont (10.15) and Georgia (1.99) had the highest and lowest state-level rates, respectively. Regionally, the West (4.61) exceeded the Northeast (3.43). Nonmetropolitan areas (4.81) had consistently higher mortality than metropolitan areas (3.85). Dyslipidemia and stroke-related mortality increased significantly after a period of stability. The highest AAMRs were observed in men, NH Black individuals, and people living in the Western US and nonmetr…
subject: Articles
  topic: section
subject: Articles
  topic: category
subject: Heart failure
  topic: keywords
subject: insulin resistance
  topic: keywords
subject: metformin
  topic: keywords
subject: empagliflozin
  topic: keywords
subject: global longitudinal strain
  topic: keywords
creator: Muhammad Muneeb Ur Rehman
creator: Iliyan Mithani
creator: Muhammad Sameer Arshad
creator: Syed Raza Shah
creator: Wolfram Doehner
creator: Anandita Kulkarni
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-31
publication date: 2025-12-31
doi: 10.4081/cardio.2025.90

Sex differences in clinical characteristics and outcomes in heart failure with mildly reduced and preserved ejection fraction
type: item
description: Heart failure with mildly reduced and preserved ejection fraction (HFmrEF and HFpEF) exhibits significant sex-based differences in clinical presentation, management, and outcomes. This study aimed to evaluate these differences using data from the Swedish Heart Failure Registry (SwedeHF). We analyzed 64,046 patients with HFmrEF or HFpEF (EF ≥40%) from the SwedeHF registry. Baseline characteristics, treatment patterns, and outcomes were compared between females and males. Multivariable logistic regression was used to evaluate predictors of guideline-directed medical therapy (GDMT) use as odds ratios (OR). Cox proportional hazards models were used to assess the risk of cardiovascular mortality and heart failure (HF) hospitalization as hazard ratios (HR), adjusting for demographic and clinical variables. Females (42.5%) were older than males (median age 79 years vs 75 years), had a higher prevalence of hypertension (73.8% vs 70.0%), and were more likely to present with severe symptoms (NYHA class III-IV: 36.8% vs 28.8%). Males had a higher prevalence of ischemic heart disease (52.3% vs 42.9%) and diabetes (27.4% vs 23.8%). Females were significantly less likely to receive SGLT2 inhibitors (OR 1.24, 95% confidence interval [CI] 1.13-1.36), while males were less likely to receive beta-blockers, digoxin, nitrates, and loop diuretics. During a median follow-up of 2.3 years, males had a higher adjusted risk of the composite outcome of cardiovascular mortality or HF hospitalization (HR 1.16, 95% CI 1.13-1.19), as well as higher risks for cardiovascular mortality (HR 1.28, 95% CI 1.23-1.32) and HF hospitalization (HR 1.12, 95% CI 1.08-1.15). Females with HFmrEF and HFpEF in the SwedeHF registry had a distinct clinical profile, were less likely to receive certain GDMTs, yet exhibited a lower risk of cardiovascular mortality compared to males. These findings underscore the importance of targeted strategies to optimize HF care for females.
subject: Articles
  topic: section
subject: Articles
  topic: category
subject: Heart failure
  topic: keywords
subject: reduced ejection fraction
  topic: keywords
subject: sex differences
  topic: keywords
subject: artificial intelligence
  topic: keywords
subject: large language model
  topic: keywords
creator: Christian Basile
creator: Stefan D. Anker
creator: Gianluigi Savarese
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-16
publication date: 2025-07-16
doi: 10.4081/cardio.2025.76

The effect of sauna on cardiac and skeletal muscle function in patients with HFpEF (SAUNA-HFpEF): rationale and design
type: item
description: Patients with heart failure with preserved ejection fraction (HFpEF) often experience dyspnea, fatigue, and exercise intolerance, which are closely linked to skeletal muscle dysfunction and structural abnormalities. The only proven intervention to enhance exercise capacity and quality of life in these patients is regular endurance exercise training. However, its long-term effectiveness is often limited due to poor patient adherence and mobility restrictions caused by sarcopenia, cachexia, or frailty. Therefore, novel therapeutic approaches targeting these unmet needs are urgently required. Sauna-HFpEF is an academic-led, mechanistic, prospective, single-arm, single-center pilot study designed to assess the safety, feasibility, and efficacy of intermittent hyperthermia (sauna therapy) in improving exercise capacity and quality of life in patients with heart failure with preserved ejection fraction (HFpEF), as well as to explore the underlying mechanisms. A total of 18 clinically stable outpatients with HFpEF were enrolled and participated in twice-weekly sauna sessions at 60°C over a 10-week period. Assessments were conducted at baseline and after the intervention, including: echocardiography, cardiopulmonary exercise testing, six-minute walk test, body composition analysis to assess skeletal muscle mass and fat tissue, isokinetic skeletal muscle strength measurement of the quadriceps, daily physical activity monitoring using wearable accelerometers for one week, blood biomarkers, including NT-proBNP, renal function, and inflammatory markers (GDF-15, IL-6), and quality-of-life questionnaires (SF-36, HADS, EQ-5D). Furthermore, to explore the underlying mechanisms of a potential sauna-induced effect, patients underwent two ultrasound-guided punch biopsies of the musculus vastus lateralis in the right quadriceps - one before and one after the intervention. The collected samples were analyzed for structural, metabolic, and mitochondrial changes to gain further insights i…
subject: Articles
  topic: section
subject: Contents
  topic: category
subject: Articles
  topic: category
subject: Sauna
  topic: keywords
subject: skeletal muscle
  topic: keywords
subject: heart failure with preserved ejection fraction
  topic: keywords
subject: exercise capacity
  topic: keywords
creator: Tarek Bekfani
creator: Kris G. Vargas
creator: Flor Gomez
creator: Alexander Schmeisser
creator: Ruediger C. Braun-Dullaeus
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
doi: 10.4081/cardio.2025.67

The Global Implementation Guidelines Initiative: how to optimize cardio-renal-metabolic care worldwide
type: item
subject: Editorials
  topic: section
subject: Contents
  topic: category
subject: Editorials
  topic: category
subject: Guidelines
  topic: category
subject: guidelines
  topic: keywords
subject: evidence-based practice
  topic: keywords
subject: implementation guidelines
  topic: keywords
subject: global guidelines
  topic: keywords
creator: Fausto J. Pinto
creator: Stefan D. Anker
creator: William T. Abraham
creator: John J. Atherton
creator: Javed Butler
creator: Vijay Chopra
creator: Andrew J.S. Coats
creator: Yann Colardelle
creator: Maria Rosa Costanzo
creator: Veronica Dean
creator: Gerasimos Filippatos
creator: Martha Gulati
creator: Julio Rosenstock
creator: John Teerlink
creator: Subodh Verma
creator: Jose Luis Zamorano
creator: Yuhui Zhang
creator: Shelley Zieroth
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-04-16
publication date: 2025-04-16
doi: 10.4081/cardio.2025.68