Out now in #EJHF from #HFC member @JavedButler1 et al. This viewpoint discusses how secondary endpoints may be interpreted when a trial fails to meet its primary endpoint, considering the number of events and supportive evidence from other trials. academic.oup.com/eurjhf/adva…

🆕 OpenSource: Cardiology — "Evaluation of Methods Used in Transitioning from Sodium Nitroprusside to Oral Vasodilators in Acute Heart Failure." Bayan M. Alghafli @AboveandBayan and colleagues at Saint Luke's Mid America Heart Institute @MidAmericaHeart studied 136 patients with acute heart failure and reduced ejection fraction who were transitioned from sodium nitroprusside to oral vasodilators under pulmonary artery catheter guidance. Forty-two (31%) came off the drip on a standardized rapid-titration order set — captopril or hydralazine-isosorbide dinitrate — and 94 (69%) on provider-directed dosing. Mean age 58.8 ± 14.0 years, 80.1% male, baseline EF 26% in both groups. Protocol-guided vs provider-directed: • Time to SNP discontinuation after oral vasodilator start: median 10.4 vs 13.7 hours (P = 0.271) • SNP reinitiation: 7.1% vs 20.2%, OR 0.3 (95% CI 0.08–1.10), P = 0.055 • Hypotensive events: median 5.5 vs 4.0 (P = 0.554) • ICU length of stay: median 5.3 vs 4.1 days (P = 0.230) • Death in hospital or within 7 days of discharge: 11.9% vs 6.4% (P = 0.314); 8.1% overall • Discharged on inotropes: 9.5% vs 16.0% (P = 0.317) • Discharge ACEi/ARB/ARNi: 45.2% vs 61.7% (P = 0.073); beta-blocker 54.8% vs 52.1%; MRA 28.6% vs 36.2% • Cardiac index and systemic vascular resistance at SNP discontinuation: no significant difference Conclusion: protocol-guided transition of SNP to short acting PO vasodilators was feasible, with broadly similar short-term tolerance and clinical outcomes compared to a provider-directed approach. @BrettSperryMD @jtsaxon @AndrewJSauer @maz_hanna @JavedButler1 @djc795 opensourcecardiology.org/doi…

The hypothesis that excess adiposity is a near-universal feature of HFpEF jacc.org/doi/10.1016/j.jacc.… The RCT analyses cited at the bottom of the figure

Efficacy of Vericiguat by Background Guideline-Directed Medical Therapy in the VICTOR Trial. doi.org/10.1093/ejhf/xuag294 Contributions from Baim faculty, @JavedButler1 and @lamcardio. #BaimInstitute #ClinicalResearch #Cardiology

Residual Inflammatory Risk of Heart Failure and Atherosclerotic CVD in Diabetes: Look AHEAD Ancillary Study. doi.org/10.1016/j.jchf.2026.… Contributions from Baim faculty, @ambarish4786, @JavedButler1, and @CBallantyneMD. #BaimInstitute #ClinicalResearch #Cardiology #HeartFailure

Overcome the barriers by design: start all 4 pillars early & low-dose in-hospital, rapid-sequence titration w/ intensive follow-up, nurse/pharmacist-led teams, tackle cost (assistance programs, generics) Systematize the approach The clinical benefits are transportable

How do we shape the future of #HF care?🫀 The @HFA_ESC × Korean Society of Heart Failure (#KSHF) joint session at #HeartFailureSeoul2026 connected three dimensions of personalized HF management: 📍Prof. @GianluSava explored personalized GDMT in HF & rethinking phenotype-based therapy 📍Prof. @WilfriedMullens translated the 2026 ESC HF Guidelines into practical messages: think beyond LVEF; treat earlier & across the HF spectrum; start fast, optimize early & continue lifelong; manage congestion dynamically; & individualize drugs, devices, interventions & comorbidity care. 📍Prof. In-Cheol Kim talked about integrating human expertise & AI to advance personalized HF management #HFS2026 #HeartFailure #ESCGuidelines @escardio @h_arfsten @jozinetm @GTersalvi @JavedButler1

The evidence is strong, but prescribing often isn't. Too many patients never start all four pillars, usually from fragmented care rather than clinical judgment. We can't leave survival on the table.

In patients with LV dysfunction(EF </= to 40%), but no history of heart failure, do you just use beta blocker and lisinopril, or do you still initiate all four treatments?

Now in JACC: Heart Failure by #HFC member Javed Butler and colleagues. This study evaluates hs-CRP and IL-6 as predictors of ASCVD and incident HF in adults with type 2 diabetes and overweight/obesity. jacc.org/doi/10.1016/j.jchf.…

💊❤️ HFrEF's 4 GDMT pillars aren't interchangeable, they stack ARNI, β-blocker, MRA & SGLT2i each ⬇️ all-cause mortality, with incremental and cumulative benefits 🛡️ Quadruple therapy: HR 0.39, ~5-6 yrs of life gained 📈 Stopping at 2–3 leaves survival on the table 🕯️

Heart failure and AI are the defining healthcare challenges and opportunities of our time. Honored to co-lead our @ARPA_H #ADVOCATE award @kpdor with an exceptional team to bring clinical trial rigor to AI evaluation. Let's go! arpa-h.gov/news-and-events/a…

A discrepancy worth considering: SELECT trial projection has GLP1RA in obesity+ASCD preventing ~2,600 US incident HF 🏨/yr (did not reach significance) Treating hypertension to goal projected to prevent many-fold more, ~167,000 US incident HF 🏨/yr

🫀 When a CV trial misses, how often is COVID the culprit vs. an excuse? 🤔 RCTs hitting their endpoint (SELECT, CLEAR, EMPEROR-Preserved, DELIVER, FINEARTS-HF, SUMMIT). RCTs missing & citing COVID (GUIDE-HF, dal-GenE, PARADISE-MI, AFFIRM-AHF, IRONMAN, SPIRIT-HF) 📊

Now that sacubitril/valsartan is generic (<$13 a month) PARAGON-HF: PEP rate ratio, 0.87; 95% CI 0.75 to 1.01; P=0.059 PARAGLIDE-HF + PARAGON-HF total events RR 0.86; 95% CI 0.75–0.98; P=0.027 S/V vs imputed placebo RR 0.71 95% CI 0.54–0.93; P=0.013 Class 2b ➡️ Class 1?

Our position statement on clinically meaningful differences in patient outcomes is out! Thankful for everyone who was part of this work! @JACCJournals @AndrewPAmbrosy @JavedButler1 @BiykemB @noshreza @jspertus @NatalieTapaskar @hfcollaboratory @ACCinTouch jacc.org/doi/10.1016/j.jchf.…

History of worsening heart failure and outcomes with vericiguat in ambulatory HFrEF: an exploratory post-hoc analysis of VICTOR. doi.org/10.1093/ejhf/xuag262 Contributions from Baim faculty, @JavedButler1 and @lamcardio #BaimInstitute #ClinicalResearch #HeartFailure #Cardiology

Complementary to EMPULSE findings ✅ Hard event ⬇️ by meta-analysis of RCTs All-cause ☠️ at 60 days median f/u ⬇️ by 39% RR 0.61, 95% CI 0.47-0.81, p=0.0005 ARR 24 per 1000 fewer ☠️s (95% CI 33 to 12) NNT 42 (95% CI 30-84) doi.org/10.1016/j.cardfail.2…

Why start SGLT2i in-🏨 (not "later")? ✅ Early decongestion by week 1
⚖️ ↓ body weight
💧 ↓ loop diuretic dose
📈 rising diuretic efficiency
❤️ quadruple GDMT started early
📉 ↓ early mortality/events
🛡️ safe
🚪 captures a key teachable moment Don't delay!

#ESCCongress #EHJCVP 🔥 HOT LINE 6: new heart failure evidence at #ESCCongress @escardio @jjheart_doc @jeemon79 @javedbutler1 @jteerlinkmd @Filippatos 🔹 H-HeFT + meta-analysis: hydralazine–isosorbide dinitrate 🔹 Met-HeFT + meta-analysis: metformin