Heart Failure

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Can AI Help Identify Advanced Heart Failure?

A recent artificial intelligence (AI)-powered approach may help identify patients with advanced heart failure using data already collected in routine care. Researchers developed a machine learning model that predicts peak oxygen consumption (peak VO2), a key measure typically obtained through cardiopulmonary exercise testing (CPET), by analyzing cardiac ultrasound images together with electronic health record data. Because CPET requires specialized equipment and staff and is often limited to large medical centers, the researchers see this approach as a potential way to make advanced heart failure assessment more accessible.

 

The model was trained on deidentified data from 1,000 patients with heart failure and then tested in 127 patients from three other New York-Presbyterian campuses. It achieved roughly 85% accuracy in distinguishing higher-risk patients based on predicted peak VO2, outperforming previously reported AI-based approaches for this task. The investigators are now planning clinical studies needed before FDA approval and routine use, with the goal of determining whether the method can help identify patients with advanced heart failure who might otherwise be missed.

 

Reference: NewYork-Presbyterian. Promising Results for AI-Powered Detection of Advanced Heart Failure. Published March 20, 2026. Accessed August 13, 2026. https://www.nyp.org/news/promising-results-for-ai-powered-detection-of-advanced-heart-failure

Daniel Thibodeau

DHSc, MHP, PA-C, DFAAPA, AACC

Physician Associate, Macon and Joan Brock Virginia Health Sciences, Eastern Virginia Medical School at Old Dominion University

Featured article

Finerenone vs Spironolactone in HFpEF

A recent Heart Failure Beat discussion examined the role of mineralocorticoid receptor antagonists (MRAs) in HFpEF and HFmrEF, with particular focus on finerenone versus spironolactone. Robert L. Page II, PharmD, MSPH, FHFSA, argued that finerenone could represent a new treatment pillar in HFpEF, citing its pharmacology, cardiorenal distribution, and randomized trial evidence, especially in patients with concomitant chronic kidney disease. Stormi Gale, PharmD, BCCP, FHFSA, emphasized a more pragmatic evidence-based approach, noting that without head-to-head trials, it is difficult to justify a substantially higher-cost option when spironolactone remains inexpensive and widely accessible.

 

The debate also addressed the importance of phenotyping in HFpEF, including the possibility that earlier trials may have enrolled patients with conditions such as amyloidosis that were not clearly recognized at the time. The panel discussed emerging evidence that combining SGLT2 inhibitors with MRAs may help reduce hyperkalemia risk and potentially support broader guideline-directed medical therapy optimization. Overall, the speakers emphasized that patient selection, treatment access, cost, and careful interpretation of evolving evidence will remain central as guidelines and cost-effectiveness data continue to develop.

 

Reference: Heart Failure Society of America. MRAs in HFpEF & HFmrEF: A Debate on Evidence, Access, and the Future. HFSA News. Published 2026. Accessed August 13, 2026. https://www.hfsa.org/mras-hfpef-hfmref-debate-evidence-access-and-future

Viet Le

DMSc, MPAS, PA-C, FACC, FAHA

As CKD Advances, HFpEF Association Strengthens

Researchers of a retrospective matched case-control study using the Swedish Heart Failure Registry found that chronic kidney disease (CKD) was independently associated with new-onset heart failure across the ejection fraction spectrum. The analysis included 51,848 patients with new-onset heart failure and an equal number of matched controls without heart failure. CKD based on diagnostic codes was associated with higher odds of developing heart failure overall, with the strongest association seen for heart failure with preserved ejection fraction (HFpEF), followed by heart failure with reduced ejection fraction (HFrEF) and heart failure with mildly reduced ejection fraction.

 

The relationship between kidney disease and heart failure also became more pronounced as CKD severity increased. Moderate-to-advanced CKD was particularly strongly associated with HFpEF, while milder CKD showed more similar associations with HFpEF and HFrEF. The researchers concluded that these findings reinforce the importance of heart failure prevention in patients with CKD and suggest that declining renal function may be especially relevant to the development of HFpEF.

 

Reference: Roy M, ed. How Declining Renal Health Shapes Heart Failure. Medscape. Published July 28, 2026. Accessed August 13, 2026. https://www.medscape.com/viewarticle/how-declining-renal-health-shapes-heart-failure-2026a1000paq?ecd=a2a&form=fpf

Daniel Thibodeau

DHSc, MHP, PA-C, DFAAPA, AACC

Heart Failure Alerts: Why Timely Action Matters

The ALLEVIATE-HF trial evaluated whether an insertable cardiac monitor combined with a centrally coordinated, nurse-led diuretic response could improve outcomes in ambulatory patients with recent symptomatic heart failure. Among 711 patients followed for a mean of 17.3 months, the approach met its prespecified safety threshold but did not significantly improve the primary composite outcome of cardiovascular death, heart failure hospitalization or outpatient events, quality of life, and six-minute walk distance. Investigators noted that many high-risk alerts were not followed by timely treatment, and accompanying editorialists emphasized that alerts alone are not enough.

 

A secondary analysis found a substantial arrhythmia burden across the cohort, with no difference in arrhythmia rates between intervention and control groups. Over longer follow-up, atrial fibrillation, bradyarrhythmias, and ventricular tachycardia or fibrillation were common. The presence of any arrhythmia was associated with more arrhythmia-related interventions, more all-cause hospitalizations, and more heart failure events. Bradyarrhythmias and pauses were more frequent in HFpEF, while ventricular arrhythmias tended to occur more often in HFrEF. The findings suggest continuous rhythm surveillance may provide useful diagnostic information, but additional studies are needed to determine whether detection-guided interventions can improve clinical outcomes.

 

Reference: American College of Cardiology. ALLEVIATE-HF: ICM-Based HF Risk Detection and CV Outcomes; Arrythmia Burden. American College of Cardiology. Published May 28, 2026. Accessed August 13, 2026. https://www.acc.org/Latest-in-Cardiology/Journal-Scans/2026/05/26/10/02/ALLEVIATE-HF

Whitney Gaydos

PA-C, AACC

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