2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T4dc,There is growing clinical interest in strategies for improving clinical outcomes in patients with heart failure (HF) and obesity. The development of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and of the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RA has expanded therapeutic options for this population. This expert consensus provides a comprehensive and pragmatic framework for the use of GLP-1 RAs and GIP/GLP-1 RA in patients with HF, focusing on clinical integration, patient selection, safety, and tolerability. We review the evidence supporting their use in patients with HF with preserved ejection fraction (HFpEF), where clinical trials have demonstrated meaningful reductions in body weight alongside improvements in health status and exercise capacity. Whether these effects translate into fewer HF events or lower cardiovascular mortality remains uncertain, as current evidence is limited to two small trials with few observed events. In contrast, data regarding the efficacy and safety of these drugs in HF with reduced ejection fraction are scarce, with dedicated outcome trials yet to be launched. Finally, this document highlights knowledge gaps and outlines future research directions in this field.31:T4fb,There is growing clinical interest in strategies for improving clinical outcomes in patients with heart failure (HF) and obesity. The development of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) and of the dual glucose‐dependent insulinotropic polypeptide (GIP)/GLP‐1 RA has expanded therapeutic options for this population. This expert consensus provides a comprehensive and pragmatic framework for the use of GLP‐1 RAs and GIP/GLP‐1 RA in patients with HF, focusing on clinical integration, patient selection, safety, and tolerability. We review the evidence supporting their use in patients with HF with preserved ejection fraction (HFpEF), where clinical trials have demonstrated meaningful reductions in body weight alongside improvements in health status and exercise capacity. Whether these effects translate into fewer HF events or lower cardiovascular mortality remains uncertain, as current evidence is limited to two small trials with few observed events. In contrast, data regarding the efficacy and safety of these drugs in HF with reduced ejection fraction are scarce, with dedicated outcome trials yet to be launched. Finally, this document highlights knowledge gaps and outlines future research directions in this field.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Heart Failure With Reduced Ejection Fraction: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Heart Failure With Reduced Ejection Fraction (condition). Clinician-written summaries and actionable practice insights. 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The authors apply sensitivity analyses but the assumption remains a key limitation.","value_numeric":null},{"paper_doi":"10.1016/j.jchf.2026.103295","tag_type":"warning","value":"Treatment rates sourced from Epic Cosmos may reflect a health-system-biased sample and may not generalize to uninsured or underserved populations.","value_numeric":null}],"summaries":{"what_studied":"This population-level decision analytic modeling study estimated the number of U.S. adults with HFrEF eligible but not receiving quadruple GDMT (ARNI, beta-blocker, MRA, SGLT2 inhibitor), and projected deaths and hospitalizations preventable with optimal implementation over 12 months, using 2022–2025 national data sources.","key_result":"Only 18.2% of an estimated 2.76 million eligible U.S. HFrEF adults received quadruple GDMT. Optimal implementation was projected to prevent ~113,747 deaths (95% UI: 90,173–149,875) and ~357,332 HF hospitalizations annually.","limitations":"Estimates rely on modeled assumptions and trial-derived NNTs applied to real-world populations, which may not fully reflect comorbidity burden or contraindication rates. Treatment rates from Epic Cosmos may not represent all U.S. practice settings. Aggregate death estimates assume independent, additive benefits across drug classes.","practice_takeaway":"More than 1.5–1.8 million HFrEF patients remain untreated for each individual GDMT class — closing these gaps could prevent over 100,000 deaths per year. Clinicians should systematically audit HFrEF patients for GDMT eligibility and prioritize initiation of ARNIs and SGLT2 inhibitors, where gaps are largest."}},{"doi":"10.1161/jaha.124.041948","pmid":"42517500","title":"ECG‐Based Artificial Intelligence for Classifying Left Ventricular Dysfunction and Heart Failure With Preserved Ejection Fraction","journal_title":"Journal of the American Heart Association","journal_issn":"2047-9980","published_at":"2026-07-28T00:00:00.000Z","url":"https://doi.org/10.1161/jaha.124.041948","source_score":21,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-06T13:22:12.860Z","updated_at":"2026-08-06T13:22:12.860Z","tags":[{"paper_doi":"10.1161/jaha.124.041948","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"condition","value":"Heart Failure With Mildly Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"condition","value":"Heart Failure With Preserved Ejection Fraction","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"condition","value":"Heart Failure With Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"condition","value":"Left Ventricular Dysfunction","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"modality","value":"Artificial Intelligence / Machine Learning","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"modality","value":"Electrocardiography","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"sample_size","value":"n=208123","value_numeric":208123},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"study_design","value":"Retrospective Cohort Study with External Validation","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"warning","value":"HFpEF prevalence was only 1–2% in both cohorts; model performance in higher-prevalence clinical settings is unknown.","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"warning","value":"Pediatric validation is exploratory given only 142 cases; AUCs for mEF and HFpEF in children should be interpreted with caution.","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"warning","value":"Sample size tag reflects combined unique patient counts from both adult cohorts (165,243 + 42,880); ECG counts are much higher (~1.15M) — clinicians should note the distinction between patient-level and ECG-level data.","value_numeric":null},{"paper_doi":"10.1161/jaha.124.041948","tag_type":"warning","value":"The study design label 'Retrospective Cohort with External Validation' is an approximation; the paper describes a model development and validation study, which does not fit a single canonical study design label perfectly.","value_numeric":null}],"summaries":{"what_studied":"An AI model trained on 12-lead and single-lead (Lead I) ECG data was developed and externally validated to simultaneously classify four categories — reduced EF (rEF, EF<40%), midrange EF (mEF, 40–50%), HFpEF, and controls — using data from two health systems (Atrium Health Wake Forest Baptist: 1,078,198 ECGs / 165,243 patients; UTHSC: 72,832 ECGs / 42,880 patients), with additional pediatric validation.","key_result":"The 12-lead ECG-AI model achieved AUCs of 0.90 / 0.81 / 0.80 for rEF / mEF / HFpEF in internal holdout data and 0.92 / 0.76 / 0.73 in external validation; single Lead I performance was close (0.89 / 0.78 / 0.75 internally; 0.90 / 0.75 / 0.74 externally). In pediatric data, 12-lead AUCs were 0.97 / 0.71 / 0.64 for rEF / mEF / HFpEF. Adding clinical risk factors to ECG-AI did not significantly improve performance.","limitations":"- HFpEF prevalence was low (1–2%) in both cohorts, which may limit model calibration and real-world generalizability.\n- Clinical-only models lacked generalizability across sites, suggesting potential dataset-specific confounding.\n- Pediatric validation included only 142 cases, limiting conclusions for that population.","practice_takeaway":"A single ECG lead may be sufficient to screen for LV dysfunction and HFpEF with clinically meaningful accuracy, opening the door to low-cost, wearable-based screening. Clinicians should note that HFpEF detection performance (AUC ~0.73–0.80) is weaker than rEF detection and warrants confirmatory testing."}},{"doi":"10.1016/j.cjca.2026.05.001","pmid":"42370863","title":"Cost-effectiveness of Pharmacist- and Nurse Practitioner-led Medication Management for Heart Failure With Reduced Ejection Fraction","journal_title":"Canadian Journal of Cardiology","journal_issn":"0828-282X","published_at":"2026-06-29T00:00:00.000Z","url":"https://doi.org/10.1016/j.cjca.2026.05.001","source_score":29,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-09T06:21:04.675Z","updated_at":"2026-09-09T06:21:04.675Z","tags":[{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"condition","value":"Heart Failure With Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"modality","value":"Guideline-Directed Medical Therapy","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"modality","value":"Nurse Practitioner-Led Medication Management","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"modality","value":"Pharmacist-Led Medication Management","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"study_design","value":"Cost-Effectiveness Analysis (Markov Model)","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"warning","value":"No empirical sample size is reported — this is a model-based simulation, not a clinical trial with enrolled participants; the sample_size tag has been omitted.","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"warning","value":"The ICER and NMB are expressed in Canadian dollars (CAD) with a CAD$50,000/QALY threshold; direct comparisons to studies using USD or other thresholds require conversion.","value_numeric":null},{"paper_doi":"10.1016/j.cjca.2026.05.001","tag_type":"warning","value":"The paper is dated June 2026 but was accessed in September 2026; it appears to be a recently published article and findings have not yet been independently replicated.","value_numeric":null}],"summaries":{"what_studied":"A Markov model compared pharmacist- and/or nurse practitioner-led HFrEF medication management vs. usual care alone in a simulated cohort of recently diagnosed HFrEF patients in British Columbia, Canada, over a lifetime horizon from a public payer perspective.","key_result":"The intervention reduced deaths (7.2 → 6.2 per 100 patients; Δ1.0) and HF hospitalizations (10.8 → 8.4 per 100; Δ2.4) at 1 year, gained +1.76 QALYs at an added cost of CAD$13,089, yielding an ICER of CAD$7,437/QALY and an incremental net monetary benefit of CAD$75,032 at a CAD$50,000/QALY threshold.","limitations":"- Model simulates a BC cohort; findings may not generalize to other health systems or payer structures.\n- Costs and effectiveness inputs were drawn from existing literature/trials, not a head-to-head prospective study.\n- The model cannot fully capture heterogeneity in real-world GDMT uptake rates or provider skill mix.","practice_takeaway":"Pharmacist- or nurse practitioner-led HFrEF medication management is highly cost-effective (ICER ~CAD$7,400/QALY), far below standard thresholds, supporting expansion of these roles to optimize GDMT use in recently diagnosed HFrEF patients."}},{"doi":"10.1001/jamacardio.2026.1552","pmid":"42268625","title":"Cost Offset With Quadruple Therapy for Heart Failure","journal_title":"JAMA Cardiology","journal_issn":"2380-6583","published_at":"2026-06-10T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13254798/","source_score":47,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-17T13:33:00.507Z","updated_at":"2026-08-17T13:33:00.507Z","tags":[{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"brand","value":"Entresto","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"condition","value":"Heart Failure With Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"generic","value":"sacubitril-valsartan","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"modality","value":"Angiotensin Receptor-Neprilysin Inhibitor","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"modality","value":"Beta-Blocker","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"sample_size","value":"n=50598","value_numeric":50598},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"study_design","value":"Economic Evaluation / Cost Analysis","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"warning","value":"Full text is under embargo until June 10, 2027; analysis is based on the abstract and results section only—some methodological details may not be fully captured.","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"warning","value":"Level of evidence assigned as 4 (modeling/economic study using registry + RCT inputs); this is not a prospective trial.","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"warning","value":"The ARNI component is implied but not explicitly named in the abstract; sacubitril-valsartan (Entresto) is tagged as the canonical ARNI for HFrEF based on standard guidelines.","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1552","tag_type":"warning","value":"The wide drug-cost range ($1,223–$16,136/year) reflects multiple pricing sources and formulary scenarios, meaning real-world net cost will vary substantially by payer and formulary.","value_numeric":null}],"summaries":{"what_studied":"This economic evaluation estimated the 1-year health care cost offset and net cost of implementing quadruple GDMT (ARNI + β-blocker + MRA + SGLT2i) at discharge in adults ≥65 years hospitalized with HFrEF, using Medicare-linked GWTG-HF registry data from 2016–2020 (n=50,598).","key_result":"Mean 1-year costs were $41,802/patient, with $25,172 driven by hospitalizations. Quadruple GDMT was modeled to reduce all-cause hospitalization costs by $9,780/patient/year (95% CI, $7,900–$11,660). With annual drug costs ranging $1,223–$16,136, net costs ranged from **$8,556 in savings to $6,347 in net cost**, with most regimens yielding net savings.","limitations":"Treatment effects were modeled multiplicatively from separate pivotal RCTs rather than a single head-to-head trial of all four agents together; the cohort is limited to Medicare patients ≥65 years, limiting generalizability to younger adults; drug costs varied widely across pricing sources, creating a broad range of net-cost estimates.","practice_takeaway":"For older adults hospitalized with HFrEF, starting full quadruple GDMT at discharge will often pay for itself by cutting rehospitalization costs—ask about formulary options to keep drug acquisition costs below the ~$9,800 hospitalization savings threshold. Prioritizing generic or lower-cost formulations of each drug class can tip most patients into net savings territory."}},{"doi":"10.1161/jaha.125.046643","pmid":"42047207","title":"Patterns of Adherence and Persistence to Triple and Quadruple Guideline‐Directed Medical Therapy Among US Patients With Heart Failure With Reduced Ejection Fraction","journal_title":"Journal of the American Heart Association","journal_issn":"2047-9980","published_at":"2026-04-28T00:00:00.000Z","url":"https://doi.org/10.1161/jaha.125.046643","source_score":4,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-09T13:50:38.440Z","updated_at":"2026-06-09T13:50:38.440Z","tags":[{"paper_doi":"10.1161/jaha.125.046643","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"condition","value":"Heart Failure With Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"modality","value":"ACE Inhibitor / ARB / ARNI","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"modality","value":"Beta Blocker","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"modality","value":"Guideline-Directed Medical Therapy","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"sample_size","value":"n=107849","value_numeric":107849},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"warning","value":"Claims data may underestimate true GDMT use if out-of-pocket or non-claims-captured prescriptions are excluded.","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the striking underuse findings (2.3% on quadruple GDMT) rather than a new intervention; clinicians should interpret accordingly.","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046643","tag_type":"warning","value":"The study identifies 'distinct profiles' of early discontinuers but specific sociodemographic/clinical factors are described in the full paper — not fully detailed in the abstract; summary reflects available abstract data only.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study examined adherence and persistence to triple and quadruple guideline-directed medical therapy (GDMT) in US patients with HFrEF, using Optum Clinformatics claims data from January 2021 to December 2022. It also identified patient profiles associated with early GDMT discontinuation via latent trajectory analysis.","key_result":"Of 107,849 HFrEF patients, only 12.3% received triple GDMT and 2.3% received quadruple GDMT. Adherence was suboptimal: 45.0% (triple) and 40.8% (quadruple). Early discontinuation occurred in 10.5% of triple GDMT patients and 11.9% of quadruple GDMT patients, with distinct sociodemographic and clinical profiles driving discontinuation.","limitations":"- Claims-based design may miss prescriptions filled outside the database or samples from clinical trials.\n- No clinical outcomes (hospitalizations, mortality) were assessed, limiting insight into the consequences of non-adherence.\n- Study period (2021–2022) may not reflect current prescribing patterns, particularly as SGLT2 inhibitors became more established.","practice_takeaway":"Fewer than 1 in 8 HFrEF patients received triple GDMT, and fewer than 1 in 25 received quadruple GDMT — well below guideline targets. Clinicians should actively screen for early discontinuation risk, especially in patients with distinct sociodemographic or clinical profiles, and deploy targeted support strategies to sustain GDMT."}},{"doi":"10.1253/circj.cj-25-1084","pmid":"42036323","title":"Prognostic Value of Mid-Range QRS Duration in Patients With Heart Failure With Reduced Ejection Fraction","journal_title":"Circulation Journal","journal_issn":"1346-9843","published_at":"2026-04-24T00:00:00.000Z","url":"https://doi.org/10.1253/circj.cj-25-1084","source_score":5,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-07T13:26:49.090Z","updated_at":"2026-06-07T13:26:49.090Z","tags":[{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"condition","value":"Heart Failure With Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"modality","value":"Electrocardiography","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"modality","value":"Guideline-Directed Medical Therapy","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"sample_size","value":"n=415","value_numeric":415},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"study_design","value":"Prospective Observational Cohort Study","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"warning","value":"Automated ECG QRS measurements were used; manual verification was not performed for all patients, which is an inherent measurement limitation.","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"warning","value":"Baseline SGLT2 inhibitor (41.9%) and ARNI (23.1%) rates were modest, reflecting early 2020 enrollment; findings may not fully reflect outcomes under fully optimized current GDMT.","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"warning","value":"LBBB was present only in the mid-range QRS group by design (narrow QRS patients were not classified for BBB), so the LBBB interaction analysis compares within mid-range QRS only—not across all three QRS categories.","value_numeric":null},{"paper_doi":"10.1253/circj.cj-25-1084","tag_type":"warning","value":"The study is single-country (Japan/Asian cohort), which may limit generalizability to non-Asian populations. Prior large Western registries form much of the existing literature on this topic.","value_numeric":null}],"summaries":{"what_studied":"This prospective observational multicenter study (ELMSTAT-HF, Japan, January 2020–October 2023) compared natural prognosis of mid-range QRS (120–149 ms) vs. narrow QRS (<120 ms) in 415 HFrEF patients on contemporary GDMT, excluding those with CIEDs or wide QRS (≥150 ms). Median follow-up was 547 days.","key_result":"The composite endpoint of all-cause death and HF hospitalization occurred in 34.5% of the mid-range QRS group vs. 12.5% of the narrow QRS group (log-rank P<0.001). After adjustment for MAGGIC risk score and NT-proBNP, mid-range QRS remained independently associated with adverse outcomes (HR 3.12; 95% CI 1.91–5.11). This risk held for both non-LBBB (HR 2.77) and LBBB (HR 3.53) subgroups.","limitations":"- Small mid-range QRS subgroup (n=87) limits precision of subgroup estimates.\n- SGLT2 inhibitor and ARNI uptake was modest at baseline (2020 enrollment), potentially underrepresenting fully optimized GDMT.\n- NRI/IDI may overestimate incremental prognostic value; adding mid-range QRS did not significantly improve AUC.","practice_takeaway":"A QRS of 120–149 ms on a routine ECG flags HFrEF patients at roughly 3-fold higher risk of death or HF hospitalization—even without LBBB—warranting closer monitoring and full GDMT optimization before considering device therapy. Clinicians should not overlook mid-range QRS simply because CRT guidelines focus on QRS ≥150 ms."}},{"doi":"10.1016/j.jacc.2026.02.5083","pmid":"41949514","title":"Obesity and Heart Failure With Reduced Ejection Fraction","journal_title":"JACC","journal_issn":"0735-1097","published_at":"2026-04-08T00:00:00.000Z","url":"https://doi.org/10.1016/j.jacc.2026.02.5083","source_score":16,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-12T13:24:30.073Z","updated_at":"2026-06-12T13:24:30.073Z","tags":[{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"condition","value":"Heart Failure With Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"condition","value":"Obesity","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"modality","value":"Obesity Pharmacotherapy","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"modality","value":"Weight Loss Intervention","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"warning","value":"No specific weight loss drug names or trial names are cited in the abstract; brand and generic drug tags could not be applied.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"warning","value":"Sample size tag omitted — this is a narrative review with no primary patient cohort.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.02.5083","tag_type":"warning","value":"The study design is a narrative review; level of evidence set to 5 (expert opinion/review), which may underestimate specific cited primary studies discussed within the full text.","value_numeric":null}],"summaries":{"what_studied":"This review examines the relationship between obesity and heart failure with reduced ejection fraction (HFrEF), covering pathophysiology, the obesity paradox, and the potential role of weight loss interventions — including obesity pharmacotherapy — in this population.","key_result":"Most patients with HFrEF are overweight or obese, yet evidence for weight loss interventions specifically in HFrEF is limited and largely derived from non-obesity-focused trials; no novel weight loss agents are currently being evaluated in dedicated HFrEF trials.","limitations":"- Evidence base is largely from non-obesity-focused trials with methodological constraints, not dedicated HFrEF obesity studies.\n- BMI is an imperfect surrogate for adiposity, complicating interpretation of existing data.\n- The obesity paradox in HFrEF (higher BMI associated with better outcomes) adds further uncertainty about intervention targets.","practice_takeaway":"Clinicians should view obesity as a modifiable disease amplifier in HFrEF patients, not merely a bystander, but should be cautious given the obesity paradox and the current lack of dedicated trial evidence for weight loss therapies in this group.\n\nUntil HFrEF-specific obesity trials emerge, treatment decisions should balance known cardiovascular risks of excess adiposity against the paradoxical survival signals seen with higher BMI in this phenotype."}},{"doi":"10.1002/ejhf.70082","pmid":"41309245","title":"Pharmacological treatment for patients with obesity and heart failure: Focus on glucagon‐like peptide‐1 receptor agonists.\n \n European Journal of Heart Failure\n \n expert consensus document","journal_title":"European Journal of Heart Failure","journal_issn":"1388-9842","published_at":"2025-11-28T00:00:00.000Z","url":"https://doi.org/10.1002/ejhf.70082","source_score":38,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-12-01","doi":"10.1002/ejhf.70082","days":"7","issn":"1388-9842","rank":"3","field":"Clinical Medicine","score":"38","category":"Cardiac & Cardiovascular Systems","categories":["Cardiac & Cardiovascular Systems"],"_categories":["Cardiac & Cardiovascular Systems"]},"pubmed":{"doi":"10.1002/ejhf.70082","title":"Pharmacological treatment for patients with obesity and heart failure: Focus on glucagon-like peptide-1 receptor agonists. European Journal of Heart Failure expert consensus document.","journal":"European journal of heart failure","methods":"","results":"","abstract":"$30","keywords":["Glucagon‐like peptide‐1 receptor agonists","HFpEF","Heart failure","Obesity"],"pubmed_id":"41309245","conclusions":"","publication_date":"2025-11-28T00:00:00"},"crossref":{"DOI":"10.1002/ejhf.70082","URL":"https://doi.org/10.1002/ejhf.70082","ISSN":["1388-9842","1879-0844"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1002/ejhf.70082","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Pharmacological treatment for patients with obesity and heart failure: Focus on glucagon‐like peptide‐1 receptor agonists.\n \n European Journal of Heart Failure\n \n expert consensus document"],"author":[{"given":"Luca","family":"Monzo","sequence":"first","affiliation":[{"name":"Centre d'Investigations Cliniques Plurithématique 1433 and INSERM U1116 ‐ DCAC, CHRU Nancy, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Université de Lorraine Nancy France"}]},{"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet Stockholm Sweden"}]},{"given":"Wilfried","family":"Mullens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost‐Limburg A.V. Genk Belgium"},{"name":"Hasselt University, Faculty of Medicine and Life Sciences Diepenbeek Belgium"}]},{"given":"Amr","family":"Abdin","sequence":"additional","affiliation":[{"name":"Internal Medicine Clinic III, Cardiology, Angiology and Intensive Care Medicine Saarland University Hospital Homburg Germany"}]},{"given":"Biykem","family":"Bozkurt","sequence":"additional","affiliation":[{"name":"Winters Center for Heart Failure Research, Cardiovascular Research Institute Baylor College of Medicine Houston TX USA"}]},{"given":"Ovidiu","family":"Chioncel","sequence":"additional","affiliation":[{"name":"Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’ Bucharest Romania"},{"name":"University of Medicine Carol Davila Bucharest Romania"}]},{"given":"Seif","family":"El Hadidi","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons in Ireland (RCSI) Dublin Ireland"}]},{"given":"Thomas M.","family":"Gorter","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen University Medical Centre Groningen Groningen The Netherlands"}]},{"given":"Riccardo M.","family":"Inciardi","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health University of Brescia Brescia Italy"}]},{"given":"Mark C.","family":"Petrie","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health University of Glasgow Glasgow UK"}]},{"given":"Gabriele G.","family":"Schiattarella","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC) Berlin Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany"},{"name":"Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) Berlin Germany"},{"name":"Friede Springer Cardiovascular Prevention Center at Charité – Universitätsmedizin Berlin Berlin Germany"},{"name":"Experimental and Clinical Research Center (ECRC), a Cooperation of Charité‐Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine (MDC) Berlin Germany"}]},{"given":"Davide","family":"Stolfo","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet Stockholm Sweden"},{"name":"Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) Udine Italy"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health University of Brescia Brescia Italy"}]},{"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"Centre d'Investigations Cliniques Plurithématique 1433 and INSERM U1116 ‐ DCAC, CHRU Nancy, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Université de Lorraine Nancy France"}]}],"issued":{"date-parts":[[2025,11,27]]},"member":"311","prefix":"10.1002","source":"Crossref","volume":null,"archive":["Portico"],"created":{"date-time":"2025-11-28T02:14:23Z","timestamp":1764296063000,"date-parts":[[2025,11,28]]},"indexed":{"date-time":"2025-11-28T02:19:15Z","timestamp":1764296355304,"date-parts":[[2025,11,28]]},"license":[{"URL":"http://creativecommons.org/licenses/by/4.0/","start":{"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000,"date-parts":[[2025,11,27]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":"$31","language":"en","relation":{},"resource":{"primary":{"URL":"https://onlinelibrary.wiley.com/doi/10.1002/ejhf.70082"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"publication_history","label":"Publication History"},"label":"Received","order":0,"value":"2025-09-06"},{"name":"accepted","group":{"name":"publication_history","label":"Publication 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Consensus","value_numeric":null},{"paper_doi":"10.1002/ejhf.70082","tag_type":"warning","value":"Effects on heart failure events and cardiovascular mortality remain uncertain and are based on two small HFpEF trials with few events.","value_numeric":null},{"paper_doi":"10.1002/ejhf.70082","tag_type":"warning","value":"Evidence in HFrEF is sparse, and dedicated outcome trials had not launched at the time of publication.","value_numeric":null},{"paper_doi":"10.1002/ejhf.70082","tag_type":"warning","value":"Summary is based on an expert consensus abstract; quantitative effect sizes and trial sample sizes are not reported.","value_numeric":null}],"summaries":{"what_studied":"An expert consensus outlines practical use of GLP-1 receptor agonists and the dual GIP/GLP-1 agonist for patients with heart failure and obesity, emphasizing HFpEF, patient selection, safety, tolerability, and clinical integration.","key_result":"In HFpEF, trials reported weight loss and improvements in health status and exercise capacity, but effects on heart failure events and cardiovascular mortality are unknown because evidence comes from two small trials with few events. Data for HFrEF are scarce, and dedicated outcome trials have not yet launched.","limitations":"Findings for HFpEF rely on two small trials with few observed events. There is a lack of dedicated outcome trials, and evidence in HFrEF is minimal.","practice_takeaway":"GLP-1–based therapy can aid weight loss and symptom improvement in HFpEF with obesity, but event and mortality benefits are unproven. In HFrEF, evidence is insufficient; use these agents with careful attention to safety and tolerability while awaiting outcomes data."}}],"initialOffset":8,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Heart Failure With Reduced Ejection Fraction"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Heart Failure With Reduced Ejection Fraction"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Heart Failure With Reduced Ejection Fraction"}}}]]

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