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Review
. 2025 Jul;30(4):715-734.
doi: 10.1007/s10741-025-10497-z. Epub 2025 Feb 20.

Worsening heart failure: progress, pitfalls, and perspectives

Cândida Fonseca  1   2   3 , Rui Baptista  4   5   6   7 , Fátima Franco  8 , Brenda Moura  9   10 , Joana Pimenta  11   12 , Pedro Moraes Sarmento  13   14   15 , José Silva Cardoso  16   17   18 , Dulce Brito  19   20   21
Affiliations
Review

Worsening heart failure: progress, pitfalls, and perspectives

Cândida Fonseca et al. Heart Fail Rev. 2025 Jul.

Erratum in

Abstract

For most patients with chronic heart failure (HF), the clinical course of the disease includes periods of apparent clinical stability punctuated by episodes of clinical deterioration with worsening signs and symptoms, a condition referred to as worsening heart failure (WHF). Over time, episodes of WHF may become more frequent, and patients may enter a cycle of recurrent events associated with deterioration in their quality of life and functional capacity, hospitalizations, and ultimately death. WHF is apparently an old concept but seems to have acquired new boundaries in terms of definition and clinical and prognostic value due to the fast-paced evolution of the HF treatment landscape and the emergence of new drugs in this setting. As a result, the management of WHF is being reshaped. In the present paper, a group of HF experts gathered to discuss the concept, prevention, detection, and treatment of WHF.

Keywords: Chronic heart failure; Emerging treatment; Expert consensus; Guideline-directed medical therapy; Management; Vericiguat; Worsening heart failure.

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Conflict of interest statement

Declarations. Ethical standards: The manuscript does not contain clinical studies or patient data. Competing interests: CF received consultancy fees, grants, and speaker’s honoraria from Astra Zeneca, Bayer, Bial, Boehringer Ingelheim, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Servier, and CSLVifor. RB received speaker, advisory board, and grant funding fees from AstraZeneca, Bayer, Bial, Boehringer Ingelheim, Lilly, Menarini, Merck, MSD, Novartis, Pfizer, Servier Portugal, and Vifor Pharma. FF received consultant fees from Bayer, AstraZeneca, Boehringer Ingelheim, and Medinfar. BM received consultant or speaking fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Servier, Novartis, Vifor pharma, and Viatris. JP received speaker and consultant fees from Astra Zeneca, Bayer, Bial, Boehringer-Ingelheim, Lilly, Merck, Novartis, Pfizer, Roche diagnostics, Servier, and CSL Vifor. PMS received consultant or speaking fees from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, and Pfizer. JSC received research, consultant, or speaking fees from AstraZeneca, Bayer, Bial, Boehringer Ingelheim, Eli Lilly, Novartis, Pfizer, Servier, and Vifor Pharma. DB received consultancy fees and lectures or scientific meeting sponsorship from Alnylam, AstraZeneca, Bayer, Bial, Boehringer Ingelheim, Novartis, and Pfizer.

Figures

Fig. 1
Fig. 1
WHF as a specific high-risk phase in the HF continuum. Repeated events include hospitalizations, ED visits, and unscheduled day hospital visits. The advanced HF phase is represented by dotted lines, as not all patients with WHF progress to an advanced state
Fig. 2
Fig. 2
Measures for early detection and prevention of WHF in HFrEF, HFmrEF, and HFpEF
Fig. 3
Fig. 3
Proposal for early pharmacological management of WHF in HFrEF. Color code for classes of recommendation: green for class of recommendation I; yellow for class of recommendation IIa; orange for class of recommendation IIb (based on the 2021 ESC Guidelines [52])
See this image and copyright information in PMC

References

    1. Butler J, Yang M, Manzi MA et al (2019) Clinical course of patients with worsening heart failure with reduced ejection fraction. J Am Coll Cardiol 73:935–944. 10.1016/j.jacc.2018.11.049 - PubMed
    1. Savarese G, Becher PM, Lund LH et al (2023) Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 118:3272–3287. 10.1093/cvr/cvac013 - PubMed
    1. James SL, Abate D, Abate KH et al (2018) Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392:1789–1858. 10.1016/S0140-6736(18)32279-7 - PMC - PubMed
    1. Bozkurt B, Ahmad T, Alexander KM et al (2023) Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America. J Card Fail 29:1412–1451. 10.1016/j.cardfail.2023.07.006 - PMC - PubMed
    1. Groenewegen A, Rutten FH, Mosterd A, Hoes AW (2020) Epidemiology of heart failure. Eur J Heart Fail 22:1342–1356. 10.1002/ejhf.1858 - PMC - PubMed