Prevent, predict, perform: novel strategies to combat heart failure
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By
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Marina M Ostojic
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Victor Aboyans
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February 3, 2026
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0 min
Innovative Approaches for Prevention, Prediction, and Management of Heart Failure
Overview
Heart failure (HF) is a multifaceted syndrome influenced by haemodynamic, metabolic, inflammatory, and comorbid factors. Recent advances emphasize integrated, personalized strategies including biomarker-guided risk assessment, precision pharmacotherapy, and structured non-pharmacologic interventions to improve prevention, prediction, and management of HF.
Background
Heart failure is not solely a cardiac condition but a complex syndrome involving multiple systemic pathways and comorbidities. Sodium intake, behavioral factors, and metabolic biomarkers play critical roles in HF pathophysiology and risk stratification. Pharmacologic innovations and lifestyle modifications continue to evolve, offering improved outcomes in diverse patient populations including those with cancer and heart transplant recipients. The integration of multi-system biomarkers and personalized exercise regimens represents a promising frontier in HF care.
Data Highlights
| Study | Intervention/Marker | Outcome | Effect Size |
|---|---|---|---|
| Sadki et al. | Sodium chloride vs sodium bicarbonate | Blood pressure, kidney function, mortality | Sodium bicarbonate lowers mortality in HF with CKD |
| Olsson et al. | Cardiac device measures during holidays | Thoracic impedance, HR variability, activity | ~10% values reached high HF risk thresholds |
| Zhang et al. | Proteomic panel (NT-proBNP, LTBP2, REN, GDF15) | HF risk prediction | AUC 0.823 for risk stratification |
| Chevli et al. | Ketone bodies + NT-proBNP + troponin | 5- and 10-year HF risk prediction | Improved predictive accuracy |
| Bhalraam et al. | SGLT2 inhibitors in cancer patients | HF hospitalizations, new HF, mortality | NNT: 39 (HF hospitalizations), 15 (new HF), 4 (mortality) |
| Edwards et al. | 4-week isometric exercise training | Blood pressure, echocardiographic measures | SBP −8.5 mmHg; improved strain and work efficiency |
| Nasser et al. | HIIT and MCT in HFpEF | Peak VO₂ and workload | Peak VO₂ +8–11%; workload +9 W; no change in chronotropic incompetence |
| De Lima et al. | Exercise training in heart transplant recipients | Peak VO₂ improvement | HIT +4.34 mL/kg/min; CT +3.49 mL/kg/min; HIT superior to MICT by +2.09 mL/kg/min |
Key Findings
- Sodium chloride and sodium bicarbonate have distinct physiological effects; sodium bicarbonate may reduce mortality in HF patients with chronic kidney disease.
- Short-term lifestyle changes during holidays can transiently increase HF risk markers such as thoracic impedance and heart rate variability.
- A plasma proteomic panel combined with clinical factors predicts HF risk with high accuracy (AUC 0.823).
- Incorporating ketone bodies with established biomarkers enhances long-term HF risk prediction.
- SGLT2 inhibitors significantly reduce HF hospitalizations, new HF diagnoses, and mortality in cancer patients, especially those treated with anthracyclines.
- Structured exercise training, including isometric and high-intensity interval training, improves blood pressure, cardiac function, and peak oxygen uptake in HFpEF and heart transplant patients.
Clinical Implications
Clinicians should consider the type of sodium salt intake in HF management, favoring sodium bicarbonate where appropriate. Biomarker panels including proteomics and metabolic markers can refine HF risk stratification and guide personalized interventions. SGLT2 inhibitors offer cardioprotective benefits in vulnerable populations such as cancer survivors. Incorporating structured exercise programs tailored to patient capacity can improve functional outcomes and cardiac performance in HF patients.
Conclusion
Advances in biomarker-guided risk assessment, pharmacotherapy, and personalized exercise regimens offer promising strategies to enhance prevention, prediction, and management of heart failure. A multi-system, integrated approach is essential to address the complex pathophysiology of HF and improve patient outcomes.
References
- Sadki et al. 2024 -- Differential cardiovascular impacts of sodium salts
- Olsson et al. 2024 -- Increased fluid accumulation and reduced activity during holidays
- Zhang et al. 2024 -- Plasma proteomics for heart failure prediction
- Chevli et al. 2024 -- Ketone bodies in multi-marker risk prediction
- Israr et al. 2024 -- Gut microbiome and heart failure risk calculator
- Bhalraam et al. 2024 -- SGLT2 inhibitors in cancer patients and heart failure
- Edwards et al. 2024 -- Isometric exercise training in HFpEF
- Nasser et al. 2024 -- Structured exercise training and chronotropic incompetence
- De Lima et al. 2024 -- Exercise training modalities in heart transplant recipients
This content is an AI-generated, fully rewritten summary based on a published scholarly article. It does not reproduce the original text and is not a substitute for the original publication. Readers are encouraged to consult the source for full context, data, and methodology.
