Heart failure (HF) is a challenging syndrome, affecting 64 million people worldwide, and is associated with high mortality rates. There are several potential biomarkers that help us diagnose the disease as well as help us assess the prognosis. Cardiac troponins I and T are effective tools for predicting poor outcomes in HF. Cardiac troponins are intracellular proteins responsible for regulating and conducting muscle contractions. They indicate cardiomyocyte injury caused by ischemia, toxins, inflammation, wall stress, and other factors. Some of these injuries may be reversible. The blood level of troponins is influenced by various factors, both physiological—such as sex, age, and weight—and pathological, including microbiological organisms, autoantibody complexes, and conditions like pulmonary embolism, stroke, sepsis, or kidney disease. Numerous studies demonstrate the effectiveness of troponin measurement in prognostication for patients with acute and chronic HF. However, it has been found that many patients with chronic heart failure have undetectable serum levels of cardiac troponins, leading to the adoption of high-sensitivity cardiac troponins (hs-cTn). Expanding this knowledge is crucial for enabling more intensive stratification and early identification of patients with poorer prognoses.

The safety of simultaneous vaccination for Respiratory Syncytial Virus (RSV) and influenza in vulnerable high-risk heart failure (HF) patients remains unclear. In an open-label, prospective study, 105 patients received concurrent influenza (Vaxigrip Tetra, season 2023/2024, Sanofi) and RSV (Arexvy, GSK) vaccinations from September 15th to November 17th, 2023. Adverse events were collected on the fourth-day post-vaccination. Overall, the vaccination was well tolerated, with the most common reaction being injection site pain (63 %). General symptoms occurred in 33 % of patients, predominantly fatigue (23 %), myalgia (12 %), and headache (9 %). Grade 3 reactions were observed in 6 % of patients, and a few experienced temperature elevation or flu-like symptoms, managing them with antipyretics. Notably, there were no exacerbations of HF, hospitalizations, or deaths within a week post-vaccination. This study indicates the safety of simultaneous influenza and RSV vaccination in high-risk HF patients, with a low incidence of mild adverse events.

Background: There is a scarcity of prospective data on the impact of available vaccinations against respiratory viruses on hard clinical endpoints in patients with heart failure (HF). Aims: We investigated whether, in the population of high-risk HF patients, simultaneous vaccination against influenza and respiratory syncytial virus (RSV) improves outcomes during the subsequent infection season. Methods: We conducted a prospective, randomized, single-centre, open-label study in which patients with high-risk HF were randomized 1:1 to simultaneous influenza and RSV vaccination or standard of care (SOC). The primary composite endpoint comprised all-cause death, HF hospitalization (HFH) or clinical signs/symptoms of infection within a 6 month follow-up period (regular structured telephone interview). Secondary endpoints were components of the composite primary endpoint. Results: Two hundred twenty patients were randomized. During the follow-up period, the primary endpoint occurred in 59% of patients in the vaccination group versus 75% in the SOC group [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.48–0.92, P = 0.01]. Regarding the secondary endpoint analyses, during 6 month follow-up, 3% in the vaccination group died compared with 5% of patients in the SOC arm (HR 0.50, 95% CI 0.12 1.99, P = 0.32), and 18% versus 16% of study participants were hospitalized for HF in the two study arms, respectively (HR 0.86, 95% CI 0.45–1.62, P = 0.64). Infection occurred in 53% of vaccinated patients compared with 68% in SOC (HR 0.68, 95% CI 0.48–0.96, P = 0.03). Conclusions: In the population of high-risk HF, simultaneous vaccination against influenza and RSV reduced the incidence of the primary outcome. The effect was driven by a significant reduction in infections.

Heart failure (HF) affects 64 million people worldwide and is one of the most prevalent causes of hospitalization in adults. Infection is believed to be one of the potential triggers that may facilitate HF decompensation and the need for hospitalization. Therefore, it seems crucial to safeguard against such a situation. Vaccinations seem to be a very reasonable option. However, this remains an underutilized solution among HF patients. This review investigates the impact of available vaccinations, including influenza, COVID-19, pneumococcal, and RSV, on prognosis in specific HF populations only, as there are pathophysiological reasons to believe that this population of patients may benefit the most from the intervention. It will provide information about the safety profile of these vaccines and summarize the available evidence on their impact on hard clinical outcomes. In summary, this article will discuss the impact of preventive vaccinations against seasonal infections in the HF population.

Background: In clinical practice, patient self-monitoring is crucial in achieving therapeutic goals in various diseases. In heart failure (HF), it is particularly important due to the increasing role of urine composition. Therefore, we proposed this study to assess the accuracy of urine chloride (uCl⁻) assessment via strip test in relation to chloride and sodium (uNa⁺) measurements in a gold-standard laboratory method. Methods: Urine samples were collected before administering morning medications. Afterwards, they were analyzed concurrently using the strip test and gold-standard laboratory method. Results: The study cohort comprised 66 patients (82% male, mean age 68 ± 12 years), of whom 65% were diagnosed with HF and 35% without HF. Across the entire cohort, a strong correlation was observed between uCl⁻ measured by both methods (r = 0.85; p < 0.001). However, the strip test was found to underestimate uCl⁻ relative to the laboratory measurements (mean difference of 18 mmol/L). Furthermore, strong correlations were observed between the methods among patients with HF and without HF (r = 0.88 vs. r = 0.71, respectively; p < 0.001 for both), where they presented similar relationship patterns. Interestingly, in patients with a low glomerular filtration rate (eGFR ≤ 60 mL/min/1.73 m²), the correlation between both methods was greater compared to those with high eGFR (>60 mL/min/1.73 m²) (r = 0.94 vs. r = 0.76, respectively; p < 0.001 for both). The relationship between uCl⁻ from the strip test and uNa⁺ from the laboratory measurement was weaker than for uCl⁻, but it was significant. Conclusions: These findings suggest that point-of-care strip tests for assessing urinary chloride demonstrate high accuracy and potential utility, particularly in patients with reduced eGFR.

Neurohormonal overactivation and the resulting sodium avidity, driving sodium retention, are important mechanisms underlying the signs and symptoms of heart failure (HF). Blockade of the renin–angiotensin–aldosterone and adrenergic systems therefore represents a central therapeutic target and cornerstone of HF pharmacotherapy, theoretically counteracting sodium avidity. Paradoxically, evidence on how neurohormonal blockade affects markers of sodium avidity, natriuresis, and diuresis remains fragmented, with no integrated summary to date. This review aims to synthesize available evidence on the impact of guideline-directed medical therapy and other HF therapies on sodium excretion/diuresis in HF [Fig. 1]. Here we present comprehensive review of available data on this topic. The scarcity of high-quality studies, small sample sizes, and conflicting results preclude definitive conclusions; accordingly, we refrain from formulating any. Interpretation is further limited by the lack of a standardized method for assessing sodium excretion independent of confounders such as renal function and dietary sodium intake, which restricts reproducibility across studies.