Tackling heart failure with multimodality preventive cardiology
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By
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Alexandr Ceasovschih
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Victor Aboyans
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August 25, 2025
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0 min
Comprehensive Preventive Cardiology Approaches in Heart Failure Management
Overview
This issue of the European Journal of Preventive Cardiology highlights multimodal preventive strategies in heart failure (HF), emphasizing exercise training, risk stratification, and lifestyle modifications. Key findings include the benefits of increased exercise frequency and duration, the prognostic value of haemodynamic indices, and the importance of early lifestyle optimization to reduce HF risk.
Background
Heart failure (HF) management requires a multifaceted approach to improve patient quality of life and clinical outcomes. Preventive cardiology integrates pharmacological, interventional, and non-pharmacological strategies such as exercise training and lifestyle modification. Recent studies have explored the role of exercise modalities, risk stratification tools, molecular markers, and lifestyle factors in HF with preserved and reduced ejection fraction. Understanding these components is essential for tailoring individualized treatment and improving prognosis.
Data Highlights
| Study | Population | Intervention/Measure | Key Outcome |
|---|---|---|---|
| Mueller et al. | HFpEF patients | Moderate continuous training (5×/week) vs. HIIT (3×/week) | Increased exercise sessions/duration improved peak VO₂ more than intensity |
| Chaikijurajai et al. | 5940 symptomatic HF patients (mean age 56.2) | Haemodynamic gain index and peak rate-pressure product | Independent predictors of mortality, aiding risk stratification |
| Nakade et al. | 1262 elderly HF patients (≥65 years) | Pre-admission exercise habit | Associated with reduced post-discharge mortality |
| Liu et al. | 35,896 Chinese participants without HF | Life’s Essential 8 (LE8) score changes | Improved LE8 linked to reduced HF risk, especially <55 years |
Key Findings
- Quality of life questionnaires tailored to HF types support holistic management and assessment of exercise-based rehabilitation effectiveness.
- Increasing exercise frequency and duration is more effective than higher intensity in improving exercise tolerance in HFpEF.
- Haemodynamic gain index and peak rate-pressure product from treadmill testing independently predict mortality in HFrEF patients.
- Pre-admission exercise habits in elderly HF patients correlate with lower mortality post-discharge, independent of frailty and comorbidities.
- Improvement in Life’s Essential 8 cardiovascular health metrics over time reduces HF risk, particularly in younger individuals.
- Beta-blocker withdrawal may be considered in HFpEF with chronotropic incompetence, while exercise training and individualized pacing offer promising alternatives.
Clinical Implications
Clinicians should incorporate validated quality of life assessments and promote structured exercise programs emphasizing frequency and duration to improve HF outcomes. Routine exercise stress testing with haemodynamic indices can enhance risk stratification and guide advanced therapy decisions. Encouraging lifestyle improvements and monitoring cardiovascular health metrics over time are critical for HF prevention, especially in younger populations.
Conclusion
Comprehensive preventive cardiology approaches integrating exercise, risk stratification, and lifestyle optimization are vital for improving quality of life and clinical outcomes in heart failure patients. Ongoing research and tailored interventions will further refine management strategies across HF phenotypes.
References
- Volterrani et al. 2024 -- Quality of life in heart failure: A scientific statement of the HFA and EAPC
- Mueller et al. 2024 -- Comparison of exercise training modalities in HFpEF: OptimEx-Clin trial
- Chaikijurajai et al. 2024 -- Risk stratification with haemodynamic gain index in chronic HF
- Dinges et al. 2024 -- Effects of exercise training on nitric oxide metabolites in HF
- Nakade et al. 2024 -- Pre-admission exercise habit and post-discharge outcomes in elderly HF
- Magrì et al. 2024 -- Chronotropic incompetence across heart failure categories
- Liu et al. 2024 -- Association between Life’s Essential 8 and risk of heart failure: Kailuan study
- Aboelsaad et al. 2024 -- Hepcidin, incident heart failure, and cardiac dysfunction in older adults: ARIC study
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