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Cardiology86290 papers

Heart failure

Last edited: 4/23/2026

Overview

Heart failure (HF) is a complex clinical syndrome characterized by the heart's inability to pump sufficient blood to meet metabolic demands, leading to significant morbidity and mortality across various populations, including children, adults, and those with comorbidities like chronic kidney disease 1210.

Diagnosis

  • Clinical Presentation: Symptoms include dyspnea, fatigue, and fluid retention 1.
  • Echocardiography: Essential for assessing ejection fraction and identifying underlying structural heart disease 35.
  • Hemodynamic Testing: Invasive hemodynamic protocols recommended for precise evaluation, especially in complex cases 5.
  • Electrocardiogram (ECG): Machine learning algorithms show promise for detecting HF but require further standardization 4.
  • Biomarkers: Natriuretic peptides (e.g., BNP, NT-proBNP) are useful for diagnosis and prognosis 13.
  • Functional Assessment: 6-minute walk test and cardiopulmonary exercise testing provide valuable insights 1324.

    • Management

  • First-Line Treatments:
    • - Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin Receptor Neprilysin Inhibitors (ARNIs) 3715. - Beta-Blockers: Recommended for reducing mortality and hospitalization 315. - Diuretics: For managing fluid overload 3.
  • Adjunctive Therapies:
    • - Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors: Shown to reduce cardiovascular events, particularly in those with CKD 859. - Cardiac Rehabilitation: Improves exercise capacity and quality of life 192122. - Telehealth: Can optimize guideline-directed medical therapy and improve clinical outcomes 31.
  • Device Therapy:
    • - Pacemakers: Conduction system pacing (CSP) as a cost-effective alternative to biventricular pacing 7. - Left Ventricular Assist Devices (LVADs): Considered for advanced HF, with considerations for concomitant tricuspid valve surgery 33.

    Special Populations

  • Pediatrics: Acute heart failure in children requires specialized pediatric cardiology care 1.
  • Elderly: Increased risk of hospitalization-associated disability and falls; tailored rehabilitation programs are crucial 1820.
  • Comorbidities:
    • - Chronic Kidney Disease (CKD): ARNIs and careful management of fluid balance are emphasized 2849. - Polypharmacy: High prevalence; careful medication management to avoid adverse interactions 9.

    Key Recommendations

  • Implement Guideline-Directed Medical Therapy (GDMT) including ACEIs/ARNIs and beta-blockers for all eligible patients with reduced ejection fraction (Evidence: Strong 315).
  • Utilize Cardiac Rehabilitation to enhance functional capacity and quality of life in HF patients (Evidence: Moderate 1921).
  • Consider SGLT2 Inhibitors in patients with HF and CKD for improved cardiorenal outcomes (Evidence: Strong 859).
  • Monitor and Manage Biomarkers such as natriuretic peptides for diagnosis and prognosis (Evidence: Moderate 13).
  • Incorporate Telehealth Solutions to optimize adherence to GDMT and improve patient outcomes (Evidence: Moderate 31).

    • Pathophysiology

    Heart failure arises from various underlying pathologies that impair the heart's ability to pump blood effectively, leading to symptoms and signs of circulatory inadequacy. The primary mechanisms include:

  • Myocardial Dysfunction: This can result from ischemic heart disease, cardiomyopathies (dilated, hypertrophic, restrictive), or myocarditis 13. In ischemic heart disease, chronic ischemia leads to myocardial cell death and weakening of the ventricular wall 1.
  • Ventricular Remodeling: Following an insult such as myocardial infarction, the ventricles undergo structural changes, including dilation and hypertrophy, which impair contractile efficiency 1.
  • Neurohormonal Activation: The body initiates compensatory mechanisms involving the sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS) to maintain cardiac output. Chronic activation of these systems contributes to further myocardial damage and fluid retention 12.
  • Impaired Diastolic Function: In heart failure with preserved ejection fraction (HFpEF), the primary issue lies in diastolic dysfunction, where the ventricles fail to relax adequately despite normal systolic function 3. This is often associated with conditions like hypertension, diabetes, and obesity 1.
  • Valvular Disease: Conditions such as aortic stenosis or mitral regurgitation can lead to heart failure by increasing the workload on the heart 1.

    • Epidemiology

    Heart failure is a prevalent and burdensome condition globally, with significant variations in incidence and prevalence across different populations:

  • Global Prevalence: Approximately 26 million adults worldwide are estimated to have heart failure, with projections indicating a rise due to aging populations and increased prevalence of risk factors 10.
  • Age Distribution: The incidence of heart failure increases markedly with age, particularly after 65 years, where it becomes a leading cause of hospitalization and mortality 10.
  • Gender Differences: Men are slightly more likely to develop heart failure than women, although women often have higher mortality rates post-diagnosis 10.
  • Risk Factors: Common risk factors include hypertension, coronary artery disease, diabetes, valvular heart disease, and lifestyle factors such as smoking and obesity 12. Chronic kidney disease frequently coexists with heart failure, exacerbating morbidity and mortality 2.
  • Geographical Variations: Developed countries show higher reported incidences due to better diagnostic capabilities, while developing regions face challenges in both diagnosis and management, leading to underreporting 10.

    • Clinical Presentation

    The clinical presentation of heart failure is diverse and depends on the underlying etiology and the phase of the disease (acute decompensation vs. chronic):

  • Symptoms: Common symptoms include dyspnea (exertional or orthopnea), fatigue, and exercise intolerance. Patients may also experience paroxysmal nocturnal dyspnea, cough, and frothy sputum 1.
  • Signs: Physical examination often reveals signs such as jugular venous distension, peripheral edema, tachycardia, and pulmonary rales. Cardiomegaly and a third heart sound (S3 gallop) may be audible 1.
  • Non-Cardiac Symptoms: Cognitive impairment, depression, and reduced quality of life are frequently reported in heart failure patients, reflecting the systemic impact of the condition 14.
  • Acute Decompensation: Acute exacerbations can present with severe dyspnea, hypotension, and signs of systemic congestion, potentially leading to cardiogenic shock 1.
  • Specific Types:
    • - Heart Failure with Reduced Ejection Fraction (HFrEF): Characterized by reduced left ventricular ejection fraction, often presenting with more pronounced symptoms and signs of fluid overload 3. - Heart Failure with Preserved Ejection Fraction (HFpEF): Patients typically present with dyspnea and exercise intolerance but with normal or near-normal ejection fractions, often complicating diagnosis 3.

    Differential Diagnosis

    Several conditions can mimic heart failure, necessitating careful differentiation:

  • Pulmonary Conditions: Asthma, chronic obstructive pulmonary disease (COPD), and pulmonary embolism can present with dyspnea and respiratory symptoms similar to heart failure 1.
  • Cardiac Disorders: Valvular heart disease, arrhythmias (especially atrial fibrillation), and cardiomyopathies need to be ruled out through echocardiography and electrocardiography 1.
  • Renal Disorders: Acute kidney injury and chronic kidney disease can cause fluid retention and electrolyte imbalances mimicking heart failure 2.
  • Metabolic and Endocrine Disorders: Thyroid disorders (hyperthyroidism or hypothyroidism) and anemia can present with fatigue and dyspnea 1.
  • Psychogenic Causes: Anxiety disorders and panic attacks can induce symptoms that overlap with heart failure, particularly in younger patients 1.

    • Complications

    Heart failure is associated with a range of serious complications that can significantly impact patient outcomes:

  • Cardiac Remodeling: Progression of ventricular dilation and hypertrophy can worsen cardiac function and increase the risk of arrhythmias 1.
  • Arrhythmias: Atrial fibrillation, ventricular tachycardia, and sudden cardiac death are common complications, particularly in advanced heart failure 1.
  • Fluid Overload: Pulmonary edema, peripheral edema, and ascites can lead to respiratory distress and systemic congestion 1.
  • Renal Dysfunction: Heart failure often leads to reduced renal perfusion, causing acute kidney injury and chronic kidney disease progression 2.
  • Thromboembolic Events: Increased risk of deep vein thrombosis, pulmonary embolism, and stroke due to stasis and altered blood flow dynamics 1.
  • Malnutrition and Cachexia: Chronic heart failure can result in reduced appetite, weight loss, and muscle wasting, further compromising functional capacity 1.
  • Neuropsychiatric Issues: Cognitive decline, depression, and anxiety are prevalent and can severely affect quality of life and adherence to treatment 14.

    • References

    Showing 100 most recent of 73415 indexed papers.

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Diagnostic Accuracy of Machine Learning Algorithms in Electrocardiogram-Based Heart Failure Detection: A Systematic Review and Meta-Analysis. The Canadian journal of cardiology 2026. link 5 Belkin MN, Fudim M, Baratto C, Grinstein J, Hollis I, Ijioma N et al.. Standardization of Baseline and Provocative Invasive Hemodynamic Protocols for the Evaluation of Heart Failure and Pulmonary Hypertension: A Scientific Statement From the American Heart Association. Circulation. Heart failure 2026. link 6 Khairallah S, Rahouma M, Demetres M, Girardi L, Gaudino M, Hirofuji A et al.. Comparison of Meta-Analytical Estimates Between Surgical Repair and Transcatheter Edge-to-Edge Repair for Atrial Functional Mitral Regurgitation. Interdisciplinary cardiovascular and thoracic surgery 2026. link 7 Zimerman A, Dal Forno A, Rohde LE, Ternes CM, Alves FD, Damiani LP et al.. Conduction System vs Biventricular Pacing in Heart Failure: The PhysioSync-HF Randomized Clinical Trial. JAMA cardiology 2026. link 8 Silva CLD, Fonseca PEO, Calice-Silva V, Ponce D, Rocha PN, Guimarães MG. Efficacy and safety of sacubitril/valsartan in patients on peritoneal dialysis: a systematic review and meta-analysis. Jornal brasileiro de nefrologia 2026. link 9 Lee JJ, Kim M, Chi G, Kumar S. Cardiovascular risk associated with polypharmacy in heart failure: a systematic review and meta-analysis. ESC heart failure 2026. link 10 Almufleh A, Brahmbhatt DH, Billia F, Clarke B, Didi A, Nair P et al.. The Canadian Heart Failure Society (CHFS) Workforce Committee Report 2024: Addressing the Challenges Facing the Heart Failure Physicians Workforce in Canada CHFS 2024 Heart Failure Workforce Report. Journal of cardiac failure 2026. link 11 Silvestre J, Brgdar A, Chen J, Di Salvo TG. Increasing Rate of Unfilled Training Positions in the Advanced Heart Failure and Transplant Cardiology Match. The American journal of cardiology 2026. link 12 Guz D, Filipescu R, Ambrosy AP, Pagnesi M, Chioncel O, Mebazaa A et al.. Non-invasive myocardial work analysis in normal, at-risk for heart failure and heart failure patients during stress testing-a systematic review: a joint session with the Romanian Society of Cardiology (part III). Heart failure reviews 2026. link 13 Vilela EM, Bento L, Antunes A, Oliveira L, Mendes M, Abreu A et al.. Cardiopulmonary exercise stress testing in Portugal: A national survey of cardiologist members of the Portuguese Society of Cardiology. Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology 2026. link 14 Bregier J, Krupski R, Gale S, Sparling A, Pisano ME, Choy-Ames M et al.. Impact of Embedded Interdisciplinary Heart Failure Teams on Achieving Guideline-Directed Medical Therapy Within Community-Based Cardiology Practices. Journal of cardiac failure 2026. link 15 Doku A, El-Harari M, Badr A, Bennis A, Ogola E, Alhabeeb W et al.. Practical Guidance on Implementation of Guideline-Directed Medical Therapy in the Management of Heart Failure: Expert Opinion From the Middle East and Africa Region. Journal of the American Heart Association 2026. link 16 Lala A, Beavers C, Blumer V, Brewer L, DE Oliveira-Gomes D, Dunbar SB et al.. The Continuum of Prevention and Heart Failure in Cardiovascular Medicine: A Joint Scientific Statement from the Heart Failure Society of America and The American Society for Preventive Cardiology. Journal of cardiac failure 2026. link 17 Marques Vidas M, Diez J, de Sequera P, Ortiz A, Romero-González G, Slon-Roblero MF et al.. Results of a national survey on the diagnosis of heart failure in nephrology clinics: a call to action. Nefrologia 2026. link 18 Reuser A, Schittenhelm J, Schröder SC, Kandels J, Richter E, Gaal L et al.. Bridging the post-hospitalization gap: a feasibility study of home-based rehabilitation in decompensated heart failure. ESC heart failure 2026. link 19 Yagi E, Matsumura K, Takabayashi K, Morimoto J, Ijichi T, Suzuki D et al.. Differential increase in peak oxygen uptake with cardiac rehabilitation among patients with stage B versus C heart failure. European journal of physical and rehabilitation medicine 2026. link 20 Miura M, Okuda S, Ohno Y, Kadokami Y, Shigetomi M, Yonehara M et al.. Impact of accidental falls on 1-year prognosis or rehospitalization in elderly hospitalized patients with heart failure undergoing cardiac rehabilitation. European journal of cardiovascular nursing 2026. link 21 Dos Santos Costa A, Barbosa CB, Guizilini S, Krainer IB, de Marqui Moraes PI, Rogério Dos Santos V et al.. REVIVE-HF: rehabilitation with immersive virtual reality and exercise in hospitalized patients with heart failure-a randomized controlled trial protocol. Trials 2026. link 22 Sun X, Ping W, Ma L. Effects of Long-Term Baduanjin Exercise on the Effectiveness and Safety of Cardiac Rehabilitation in Patients with Chronic Heart Failure: A Systematic Review and Meta-Analysis. Journal of integrative and complementary medicine 2026. link 23 Scrutinio D, Guida P, Passantino A. Interaction of Risk of Death and Improvement in Functional Capacity After Cardiac Rehabilitation on Heart Failure Prognosis. The American journal of cardiology 2026. link 24 Kanazawa N, Tani T, Naito K, Yamana H. Association between inpatient cardiac rehabilitation and 30-day readmission in patients with heart failure: Findings from a propensity score-weighted Pseudo-population analysis. International journal of cardiology 2026. link 25 Tamura S, Inokuma M, Hattori M, Tani Y, Ito Y, Okazaki S et al.. Examination of functional characteristics related to physical function improvement in older adults with heart failure and low physical function. Physiotherapy theory and practice 2026. link 26 Shetty VV, Patil LR, Patil SG, Aithal K, Oli AK, Yenagi VA et al.. Exploring the mechanisms of yoga-based cardiac rehabilitation in heart failure via assessment of endothelial function, genomics and arterial health (Yoga-EndOmics): a study protocol. BMJ open 2026. link 27 Sugimoto N, Matsugaki R, Cooray U, Kuhara S, Onoue T, Saeki S et al.. Safety of Early Rehabilitation for Acute Heart Failure Using Japanese Medical Claims. Journal of the American Heart Association 2026. link 28 Biegus J, Tymków R, Butler J, Metra M, Chioncel O, Chopra V et al.. Attitudes towards using single-pill combination (polypill) therapy in heart failure: patients' and physicians' perspectives. ESC heart failure 2026. link 29 Tang J, Lv B, Han J, Li K, Li Q, Hu Y. The guanylate cyclase stimulator vericiguat: Insights and adverse events from a FAERS-based pharmacovigilance study. International journal of clinical pharmacology and therapeutics 2026. link 30 Yousefzai R, Bhimaraj A, Kiernan MS, Abraham J, Gorgoshvili I, Tedford RJ et al.. Mechanically Reducing Cardiac Preload With the preCARDIA System in Acutely Decompensated Heart Failure. JACC. Heart failure 2026. link 31 Chen YJ, Liao PH, Hung CL, Chang WH, Shih SC. Impact of telehealth care on clinical outcomes in heart failure patients. Journal of telemedicine and telecare 2026. link 32 Jeemon P, Salim R, Safvan K, Philip G, Kapoor A, Rashid A et al.. Financial Burden, Out-of-Pocket Health Spending, and Household Economic Well-Being in Heart Failure Patients in India: A Multicentre Cross-Sectional Survey. Global heart 2026. link 33 Färber G, Zimpfer D, Garbade J, Lavee J, Morshuis M, Shaw S et al.. Concomitant Tricuspid Valve Surgery During HeartMate 3 LVAD Implantation and Long-Term Outcomes: Insights From the ELEVATE Registry. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2026. link 34 Xie Y, He H, Li Y, Chen Q, Fu S, Wang Z et al.. Eicosapentaenoic acid attenuates heart failure with preserved ejection fraction via promoting TREM2-dependent efferocytosis. Phytomedicine : international journal of phytotherapy and phytopharmacology 2026. link 35 Golbus JR, Basu T, Luff E, Hu Y, Zeng D, Gesierich C et al.. Temporal Variation in Psychosocial Factors and Physical Activity Levels Among Patients With Heart Failure. Circulation. Heart failure 2026. link 36 Belfort DSP, Furlan DAG, Cafezeiro CRF, Wanderley MRB, Salemi VMC, Rocon C et al.. Impaired myocardial work in heart failure with improved ejection fraction: A post hoc analysis from the CATHEDRAL-HF trial. International journal of cardiology 2026. link 37 Hirakawa K, Kono Y, Kamiya K, Iida Y, Saitoh M, Taya M et al.. Development and validation of a scoring system to predict hospitalization-associated disability in older patients with heart failure: a multicenter prospective registry. European geriatric medicine 2026. link 38 Taguchi T, Yoshioka D, Tonai K, Fukushima S, Yanagino Y, Kitahata N et al.. 5-Year Outcomes of Magnetically Levitated Left Ventricular Assist Device in Advanced Heart Failure　- Japanese Cohort. Circulation journal : official journal of the Japanese Circulation Society 2026. link 39 Ozonat K, Centen C, Smith S, Aydemir VB, Fudim M, DeVore AD. Bioimpedance phase angle is associated with increased heart failure hospitalization risk. American heart journal 2026. link 40 DeVore AD, Majmudar M, Etters L, Xie J, Hao C, Lam PH et al.. Digital Platform to Optimize Guideline-Directed Heart Failure Therapy: Results of the AIM-POWER Trial. Circulation. Heart failure 2026. link 41 Wan C, Liu K, Ge MW, Li W, Shen LT, Hu FH et al.. Sex-related Incidence of Stroke After Left Ventricular Assist Device Implantation: A Systematic Review and Meta-analysis. Journal of cardiothoracic and vascular anesthesia 2026. link 42 Vasti E, Zheng J, Kalwani NM, DeJong C, Bhatt AS, Ambrosy AP et al.. Patient-Reported Health Status Among Patients With Heart Failure With Improved Ejection Fraction. Journal of the American Heart Association 2026. link 43 Cotter G, Davison BA, Mann DL, Biegus J, Termaaten JM, Pagnesi M et al.. Acute Heart Failure: Transitioning From Symptom-Based Care to Remission. Journal of cardiac failure 2026. link 44 Iturriagagoitia A, Calle S, Van Overmeiren T, De Buyzere M, Donal E, Timmermans F. Quantitative Doppler Shape Analysis in Functional Tricuspid Regurgitation. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2026. link 45 Liao S, Zhou X, Xiong Y, Zhao Q, Peng Y, Zhang X et al.. A Cluster of Potential Molecular Contributors in Myocardial-Tissue-Derived In Situ Proteomic Profiling Mediate Myocardial Hypertrophy Linked to Right Heart Dysfunction. Journal of proteome research 2026. link 46 Smith AB, Forster AK, Webster-Dekker KE, Wierenga KL. Unique contributions of heart failure and chronic pain on physical function and quality of life in older adults. Geriatric nursing (New York, N.Y.) 2026. link 47 Chen JY, Pan HC, Wu VC. Association of Angiotensin Receptor-Neprilysin Inhibitors Use and Better Cardiorenal Outcomes in Patients With Heart Failure and Acute Kidney Disease. Cardiovascular drugs and therapy 2026. link 48 Zhang L, Peng L, Liu Z, Chen J, Peng K, Wu M et al.. Development and validation of diagnostic and prognostic models for heart failure in unstable angina patients. Open heart 2026. link 49 Fujimoto Y, Kitai T, Horiuchi Y, Kondo T, Murai R, Matsukawa R et al.. Chronic kidney disease and contemporary guideline-directed medical therapy during hospitalization in patients with heart failure: Insights from PRE-UPFRONT-HF. Journal of cardiology 2026. link 50 de Goes Marques CR, Santos ES, da Silva LS, de Castro Guimarães EA, Dos Santos TG, Dos Santos Sales VB et al.. Effectiveness of an Educational Intervention With Home Visits and Telephone Follow-Up on Knowledge and Quality of Life in Patients With Heart Failure: A Randomized Clinical Trial. Nursing & health sciences 2026. link 51 Chang CY, Chen CC, Tsai ML, Hsieh MJ, Lee CH, Chen TH et al.. Prognostic value of peak tricuspid regurgitation velocity in hospitalized patients with heart failure with preserved ejection fraction: an multi-institutional study. Annals of medicine 2026. link 52 Fensore C, Deshpande A, Carrillo-Larco RM, Patel SA, Ho JC. Beyond Composite Indices: Comprehensive Social Determinants Improve Heart Failure Readmission Prediction. Journal of the American Heart Association 2026. link 53 Huang D, Liang J, Zhou Y, Pan X, Liu Z. Association of thyroid nodules with comorbidity burden and prognosis in patients with heart failure, anemia, and hyperuricemia: a retrospective cohort study. Frontiers in endocrinology 2026. link 54 Zhu MM, Zhuang YY, Duan LZ, Sun AY, Guo LL. Feasibility of using synthetic myocardial extracellular volume fraction derived from blood CT attenuation for the differentiation of heart failure. The international journal of cardiovascular imaging 2026. link 55 Sharma S, Giri G, Desai A, Ruiz J, Gomez V, Goswami R. Managing Obesity in Heart Failure Patients: Current Evidence and Strategies. The American journal of cardiology 2026. link 56 Romo M, Yuste C, Vélez J, Hernández M, Palacios B, Pita R et al.. Clinical outcomes, health care resource utilization and costs by renal function in patients with heart failure. Revista espanola de cardiologia (English ed.) 2026. link 57 Kim KH, Kim CJ, Seo EJ, Park JS, Seo KW, Ahn JA. Factors Influencing Self-Care Among Patients With Heart Failure Based on the Situation-Specific Theory: A Cross-Sectional Study. International journal of nursing practice 2026. link 58 de Alcantara Lima N, Rahman N, Afonso LC, Waldo SW, Don CW, Nathan A et al.. Clinical Outcomes and Haemodynamics: High Output Heart Failure Versus Heart Failure With Preserved Ejection Fraction. Heart, lung & circulation 2026. link 59 Al-Abdouh A, Jabri A, Mhanna M, Alhuneafat L, Ghanem F, Mortada I et al.. The early initiation of sodium-glucose cotransporter-2 inhibitors in patients with decompensated heart failure: A systematic review and meta-analysis. Current problems in cardiology 2026. link 60 Egami Y, Kobayashi N, Sugino A, Abe M, Osuga M, Nohara H et al.. Predictors of improvement in heart failure with preserved ejection fraction after catheter ablation in patients with atrial fibrillation. Heart rhythm 2026. link 61 Nozaki A, Kondo T, Nagai S, Imaizumi T, Mizuno C, Komeyama S et al.. Trajectories of Biomarkers Before and After Hospitalization for Heart Failure in Patients With Heart Failure. Circulation journal : official journal of the Japanese Circulation Society 2026. link 62 Fernandes BR, Newton JA, Betts K, Sheehan C. Comprehensive Symptom Assessment of Patients With End-Stage Heart Failure Referred to Palliative Care. Heart, lung & circulation 2026. link 63 Uriel N, Sayer GT, Elad B, Fried JA, Raikhelkar JK, Lotan D et al.. Heart Replacement Therapy in Young Patients: A Comparative Analysis of HeartMate 3 LVAD and Heart Transplant Using MOMENTUM 3 and UNOS Registry. JACC. Heart failure 2026. link 64 Patel SG, Spertus JA, Fu Z, Jones PG, Gelijns AC, Patel K et al.. 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GRSF1 Protects Against Heart Failure by Maintaining BCAA Homeostasis. Circulation 2026. link 73 Kouzu H, Yano T, Katano S, Kawaharata W, Numazawa R, Nagaoka R et al.. Protective association of renin-angiotensin system inhibitor use with skeletal muscle wasting in diabetic heart failure. Journal of diabetes investigation 2026. link 74 Wleklik M, Diakowska D, Lee CS, Vellone E, Lisiak M, Szczepanowski R et al.. Risk factors for adverse clinical outcomes in elderly patients with heart failure and cognitive frailty. Applied nursing research : ANR 2026. link 75 Li M, Chen L, Jiang Y. Influencing factors of self-regulation fatigue in older adults with chronic heart failure: A structural equation model. Geriatric nursing (New York, N.Y.) 2026. link 76 Chen X, Zhang X, Yang M, Shan C, Zhang L, Yan J et al.. The influence of non-cardiac comorbidities burden on heart failure with improved ejection fraction: Evaluated by Charlson comorbidity index. 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