Cardiac Management and Outcomes in Heart Failure

Heart failure represents a leading cause of morbidity and mortality worldwide, driven by an ageing population and rising prevalence of comorbidities such as hypertension, diabetes and ischaemic heart disease. Management encompasses pharmacological regimens—principally beta-blockers, renin–angiotensin system inhibitors, mineralocorticoid receptor antagonists and more recently sodium-glucose cotransporter-2 inhibitors—alongside device therapies, lifestyle modification and structured rehabilitation. Despite advances in guideline-directed medical therapy, adherence and persistence remain suboptimal, particularly among older patients and those with recurrent hospitalisations. Hospital readmission rates within 30 to 90 days remain high, reflecting the complex interplay of residual congestion, comorbidity burden, socioeconomic factors and fragmented care transitions. Outcomes differ by left ventricular ejection fraction phenotype, with patients classified as heart failure with reduced, mid-range or preserved ejection fraction exhibiting distinct responses to therapy and prognosis. Emerging strategies emphasise multidisciplinary education, home-based monitoring, personalised risk stratification and novel pharmacological agents targeting neurohormonal and metabolic pathways. A global focus on integrated care pathways, digital health technologies and rehabilitation programmes seeks to reduce readmissions, improve quality of life and extend survival.

Research from Nature Portfolio

Recent studies have characterised pharmacotherapy patterns following hospitalisation for heart failure, revealing that although initiation of foundational therapies such as beta-blockers, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors increases after discharge, long-term persistence remains limited. Analyses of adherence metrics demonstrate average proportions of days covered below 80 per cent for several drug classes, with only 30–60 per cent of patients maintaining continuous therapy over the first year. Vulnerable groups—particularly those aged over 75 or with prior admissions—exhibit the lowest persistence, highlighting a critical gap between guideline recommendations and real-world practice.

Cardiac Management and Outcomes in Heart Failure publication trend

The graph below shows the total number of articles in cardiac management and outcomes in heart failure across all publications each year (not limited to Nature Index journals).

Technical terms

Acute decompensated heart failure (ADHF): A sudden worsening of heart failure symptoms requiring urgent hospitalisation and management.

Left ventricular ejection fraction (LVEF): The percentage of blood ejected from the left ventricle per heartbeat, used to classify heart failure phenotypes (reduced, mid-range, preserved).

Mineralocorticoid receptor antagonists (MRAs): A class of drugs that block aldosterone receptors to reduce fluid retention and adverse cardiac remodelling.

Proportion of days covered (PDC): An adherence metric indicating the fraction of days a patient has medication available over a specified period.

Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors): Medications originally developed for diabetes that improve heart failure outcomes through natriuresis and metabolic effects.

References

1. Initiation and continuation of pharmacological therapies in patients hospitalized for heart failure in Japan. Scientific Reports (2024).
2. Demographics, Management, and In-Hospital Outcome of Hospitalized Acute Heart Failure Syndrome Patients in Contemporary Real Clinical Practice in Japan ― Observations From the Prospective, Multicenter Kyoto Congestive Heart Failure (KCHF) Registry ―. Circulation Journal (2018).
3. Association of Mineralocorticoid Receptor Antagonist Use With All-Cause Mortality and Hospital Readmission in Older Adults With Acute Decompensated Heart Failure. JAMA Network Open (2019).