Since the prevalence of heart failure (HF) increases with age, HF is now one of the most common reasons for the hospitalization of elderly people. Although the treatment strategies and overall outcomes of HF patients have improved over time, hospitalization and mortality rates remain elevated, especially in developed countries where populations are aging. Therefore, this paper is intended to be a valuable multidisciplinary source of information for both doctors (cardiologists and general physicians) and pharmacists in order to decrease the morbidity and mortality of heart failure patients. We address several aspects regarding pharmacological treatment (including new approaches in HF treatment strategies [sacubitril/valsartan combination and sodium glucose co-transporter-2 inhibitors]), as well as the particularities of patients (age-induced changes and sex differences) and treatment (pharmacokinetic and pharmacodynamic changes in drugs; cardiorenal syndrome). The article also highlights several drugs and food supplements that may worsen the prognosis of HF patients and discusses some potential drug–drug interactions, their consequences and recommendations for health care providers, as well as the risks of adverse drug reactions and treatment discontinuation, as an interdisciplinary approach to treatment is essential for HF patients.

Background: Assessment of cognitive impairment and the presence of subclinical atherosclerosis are very important especially in patients with cardiovascular risk factors. Methods: We included 155 hypertensive patients (84 with AF versus 71 without AF) to identify the premature cognitive impairment, the earliest signs of subclinical atherosclerosis and onset of myocardial dysfunction and to evaluate the type of anticoagulation used, the importance of CHA₂DS₂-VASc score (3), age (65 years) in hypertensive patients with AF. Results: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), Left Ventricular Ejection Fraction (LVEF) were significantly decreased, and Activities of Daily Living Score (ADL), Geriatric Depression Scale(GDS-15), and intima–media thickness (IMT) were significantly increased in hypertensive patients with AF vs. without AF (p < 0.05). MMSE was significantly decreased, ADL and IMT were significant increased in patients with AF and CHA₂DS₂-VASc>3 and non-vitamin K antagonists oral anticoagulants therapy (NOACs)(p < 0.05). Patients with age >65 with AF had higher rates of cognitive impairment (MMSE significant decrease) and a larger IMT (significant increase) versus patients with AF and age <65 (p < 0.05). Conclusions: Cognitive impairment is encountered in hypertensive patients having AF. Our conclusions suggest a direct link between cognitive impairment, depression, hypertension, AF, age, CHA₂DS₂-VASc score, type of anticoagulants used, LVEF, cognitive parameters, and IMT. We acknowledge the importance of identifying and preventing cognitive changes.

Urinary tract infections (UTIs) remain a leading cause of healthcare-associated morbidity, particularly in patients with indwelling urinary catheters. This study aimed to compare catheter-associated (CAUTIs) and non-catheter-associated UTIs of the lower tract among hospitalized adults in Western Romania, identify potential predictors of prolonged hospital stay, and explore the interplay of inflammatory markers and clinical outcomes. We retrospectively examined 130 patients diagnosed with UTIs from 2020 to 2024. Demographic data, comorbidities, laboratory parameters (CRP, procalcitonin, fibrinogen, white blood cell counts), and microbiology results were assessed. Patients were divided into CAUTI (n = 72) and non-catheter UTI (n = 58) groups. CAUTI patients had a significantly longer mean hospital stay (13.9 ± 4.3 vs. 11.7 ± 3.8 days, p = 0.01). E. coli (29.2%), Klebsiella pneumoniae (18.5%), and mixed flora (11.5%) predominated overall, with Pseudomonas aeruginosa trending higher in CAUTIs (15.3% vs. 5.2%). Diabetic status correlated with higher CRP (54.7 ± 18.2 vs. 46.9 ± 15.7 mg/dL, p = 0.04) and increased intensive care unit (ICU) admission (23.5% vs. 9.4%, p = 0.03). In a subgroup of 65 patients, CRP demonstrated a moderate positive correlation with length of stay (r = 0.47, p = 0.02). Logistic regression indicated that CAUTI was associated with 2.3-fold higher odds of extended hospitalization (95% CI: 1.2–4.4, p = 0.02), adjusting for age, diabetes, and CRP levels. CAUTIs are linked to more resistant pathogens, longer hospitalizations, and potentially greater clinical complications. Diabetes further compounds risk, as reflected in higher inflammatory markers and ICU admissions.

Background/Objectives: Obstructive urosepsis mandates rapid source control, yet actionable time-to-decompression (TTD) thresholds and the influence of diversion route remain debated. This review synthesized evidence on TTD, early outcomes, and predictive biomarkers. Methods: Following PRISMA-2020, ten studies met eligibility: three large administrative cohorts and seven clinical series/trials comparing outcomes by TTD and/or initial decompression (retrograde stent [RUS] vs. percutaneous nephrostomy [PCN]) and reporting biomarkers. Results: Delays were consistently harmful. In a national cohort, a TTD of ≥ 2 days increased in-hospital mortality (adjusted OR, 1.29; 95% CI, 1.03–1.63). Another analysis showed mortality of 0.16% with ≤48 h vs. 0.47% when delayed (derived OR, 0.43; p = 0.044). Absence of decompression yielded the highest mortality (19.2% vs. 8.82%; OR, 2.6; 95% CI, 1.9–3.7). Septic shock remained frequent despite low crude mortality in clinical series: 20.8% and 33.3% across two cohorts. Post-decompression urosepsis occurred in 18.7% in a randomized study and was associated with pyonephrosis and higher procalcitonin (PCT). An ED cohort showed that earlier stenting reduced length of stay (≤6 h: 35.6 h vs. 71.6 h, p = 0.01; ≤10 h: 45.7 h vs. 82.4 h, p = 0.04). Modality effects were modest; one cohort reported higher ICU use with PCN vs. RUS (OR, 3.23; 95% CI, 1.24–8.41), likely reflecting confounding by indication. Conclusions: Across designs, timeliness—not device choice—was the dominant determinant of early outcomes. Biomarkers (notably, PCT) and imaging features can prioritize ultra-early decompression.

Background and Objectives: Early bedside tools that flag non-response in hospitalized adults with lower urinary tract infection (UTI) could align clinical care with antimicrobial stewardship. We evaluated REACT-UTI, a 72 h composite combining C-reactive protein (CRP) clearance ≥35%, defervescence (temperature < 37.5 °C), and ≥2-point symptom improvement, to predict early non-response and hospital length of stay (LOS), and we assessed modifiable processes of care. Methods: We conducted a prospective observational study of adults with culture-confirmed lower UTI (n = 126) admitted to a tertiary hospital in Timișoara (December 2023–August 2025). The primary outcome was 72 h early clinical response (ECR) defined by REACT-UTI. Multivariable logistic regression examined associations of catheter-associated UTI (CAUTI), time-to-effective therapy, baseline CRP, diabetes, early catheter removal/exchange (≤48 h), and early intravenous-to-oral switch (≤72 h) with non-response. Results: Overall, 76/126 patients (60.3%) achieved ECR. Non-responders more often had CAUTI, higher baseline CRP, longer time-to-effective therapy, ESBL or fluoroquinolone-resistant Enterobacterales, and longer LOS (14.1 vs. 9.8 days; p < 0.001). Adjusted models showed that CAUTI, delayed active therapy, higher baseline CRP, and diabetes increased the odds of non-response, whereas early catheter removal (adjusted odds ratio [aOR] 0.5, 95% confidence interval [CI] 0.3–0.9) and early IV-to-oral switch (aOR 0.4, 0.2–0.8) were protective. Greater CRP clearance correlated with shorter LOS (ρ = −0.52; p < 0.001). Conclusions: In this single-center setting with a high burden of antimicrobial resistance, REACT-UTI at 72 h identified patients at risk of early non-response and prolonged hospitalization and highlighted actionable levers—timely active therapy, catheter management, and early oral step-down. External validation in diverse settings is needed before broader implementation.

Background/Objectives: Acute heart failure (AHF) is a leading cause of global morbidity, necessitating the search for reliable biomarkers to guide risk stratification. While hyperuricemia is highly prevalent in heart failure patients and historically considered a potential “cardiotoxin”, contemporary evidence suggests that it may function as a surrogate biomarker for cardiometabolic distress rather than an independent driver of myocardial dysfunction. This study aimed to determine whether serum uric acid acts as an independent predictor of left ventricular ejection fraction (LVEF) in a high-risk cardiometabolic cohort. Methods: This retrospective, cross-sectional study analyzed 306 patients hospitalized for acute heart failure at a tertiary hospital in Timisoara, Romania. Data were analyzed using JASP (v0.96). Statistical methods included Shapiro–Wilk testing, Spearman’s rank-order correlation, and independent samples t-tests. Multivariable ordinary least squares linear regression and maximum likelihood logistic regression were employed to identify predictors of LVEF and diagnostic classification, adjusting for comorbidities and diuretic administration. Results: Hyperuricemia was present in 64.6% of the cohort. Multivariable linear regression demonstrated that while age, sex, and diuretic use significantly predicted LVEF variance, serum uric acid did not (p = 0.356). Furthermore, logistic regression confirmed uric acid possessed no diagnostic utility in differentiating heart failure phenotypes (OR = 0.995; p = 0.973). Conclusions: Serum uric acid is not an independent predictor of reduced ejection fraction in acute heart failure patients. Elevated uric acid appears to be a biochemical shadow of generalized metabolic distress, systemic congestion, and the pharmacokinetic effects of diuretic therapy rather than a pathological driver of contractile dysfunction.