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Aims: There is a lack of specific studies assessing the impact of natriuretic peptide monitoring in the post‐discharge management of patients with heart failure (HF) and preserved ejection fraction (HFpEF), throughout the vulnerable phase following acute HF hospitalization. The NICE study aims to assess the clinical benefit of incorporating N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) into the post‐discharge management of HFpEF patients. Methods and results: Individuals admitted with HFpEF (left ventricular ejection fraction >50%) were included in a multicentre randomized controlled study employing an open‐label design with event blinding (NCT02807168). Upon discharge, 157 patients were randomly allocated to either NT‐proBNP monitoring (n = 79) or no access to NT‐proBNP (control group, n = 78) during pre‐scheduled visits at 2, 4 and 12 weeks. Clinical endpoints were evaluated at 6 months. The primary endpoint of HF rehospitalizations occurred in 12.1% patients, without significant differences observed between the NT‐proBNP monitoring group (12.8%) and the control group (11.4%) (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.47–2.81, p = 0.760). Regarding secondary endpoints, the NT‐proBNP monitoring group demonstrated a significantly lower risk of death (1.3% vs. 10.1%; HR 0.12, 95% CI 0.02–0.98; p = 0.048), whereas non‐HF hospitalizations (12.8% vs. 19.0%, p = 0.171) and any adverse clinical event (26.9% vs. 36.7%, p = 0.17) did not reach statistical significance [Correction added on 29 April 2024, after first online publication: In the preceding sentence, "95% CI 0.02 ‐ 0.09" has been corrected to "95% CI 0.02 ‐ 0.98; p = 0.048" in this version.]. Awareness of NT‐proBNP levels were associated with higher doses of diuretics and renin–angiotensin system inhibitors (angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers) in the NT‐proBNP monitoring group. Conclusions: Post‐discharge monitoring of NT‐proBNP in HFpEF patients did not exhibit an association with reduced rates of HF hospitalization in this study. Nonetheless, it appears to enhance global clinical management by optimizing medical therapies and contributing to improved overall survival. [ABSTRACT FROM AUTHOR]

This article discusses the use of sacubitril/valsartan, a medication that inhibits the renin-angiotensin-aldosterone system and increases the level of vasodilatory peptides, in the treatment of heart failure with reduced ejection fraction (HFrEF). The article highlights the uncertainty surrounding the underlying mechanisms of sacubitril/valsartan and the limited studies on its effects on myocardial performance and oxygen metabolism. A recent study conducted on stable patients with HFrEF found that sacubitril/valsartan had a myocardial oxygen-sparing effect compared to valsartan, although it did not significantly improve cardiac efficiency. The article concludes that further investigations are needed to fully understand the effects of sacubitril/valsartan on ventricular remodeling and clinical outcomes. [Extracted from the article]

Therefore, Canadian,[3] European,[4] and North American[5] HF guidelines have established the highest class of recommendation for these drugs and have transformed the classic, academic treatment algorithm into a more apparently simple one with only one step, leading to the inconclusive debate on how to put it into practice. Sodium-glucose cotransporter-2 inhibitors for heart failure: Time is up for indulging in wishful thinking B This article refers to 'Potential global impact of sodium-glucose cotransporter-2 inhibitors in heart failure' by K.M. Talha I et al i ., published in this issue on pages 999-1009. b Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have revolutionized the pharmacological treatment for patients with heart failure (HF) in last years. [Extracted from the article]

Aims Methods and results Conclusion No study has analyzed the impact of guideline‐directed medical therapy in preventing heart failure (HF) relapse in patients with arrhythmia‐induced cardiomyopathy (AiCM) following left ventricular ejection fraction (LVEF) improvement.We analyzed data from a single‐center cohort of 200 patients admitted for HF, LVEF <50% and cardiac arrhythmia considered by cardiologists to be the precipitating cause of the episode. The primary endpoint was time‐to‐HF relapse, defined as the composite of readmission for HF, Emergency Department (ED) visit for HF, or significant decline in LVEF. Changes in medication were recorded and a time‐varying multivariate Cox regression was performed. After a median follow‐up period of 6.14 years, diagnostic confirmation was achieved in 188 out of the initial 200 patients with suspected AiCM. A total of 89 patients (47.3%) met the primary endpoint. RAS inhibitors (adjusted hazard ratio (HR) 0.50 [0.31–0.81]; p = 0.005) and beta‐blockers (adjusted HR 0.48 [0.28–0.81]; p = 0.006) were associated with a lower incidence of relapse. Mineralocorticoid receptor antagonists were associated with a significantly lower incidence of ED visits for HF (adjusted HR 0.38 [0.15–0.95]; p = 0.038), but did not achieve statistical significance for the combined primary endpoint. Antiarrhythmic drugs did not show a significant impact on the primary endpoint.Maintaining RAS inhibitors and beta‐blockers was associated with a significantly lower incidence of relapse in the setting of AiCM with improved LVEF. [ABSTRACT FROM AUTHOR]