Background and objectives: Nutritional disorders are common in patients with heart failure (HF) and are associated with reduced functional capacity and poor prognosis. In this study, we evaluated the prognostic, nutritional and functional impact of a structured nutritional intervention in patients with chronic HF at risk of malnutrition. Methods: This is a prespecified subanalysis of the randomized controlled trial Prognostic And Clinical iMpAct of a Nutritional intervention in patients with chronic HF (PACMAN-HF). Ambulatory patients with chronic HF at risk of malnutrition were identified using the Mini Nutritional Assessment (MNA) questionnaire and randomized to receive either an individualised nutritional intervention (intervention group) or standard care (control group). We evaluated the frequency of malnutrition risk and the impact of the intervention on clinical outcomes, defined as a composite of all-cause mortality or time to first HF hospitalisation, as well as nutritional status and functional capacity at 3- and 12-month follow-ups. Results: A total of 225 patients were screened. Of these, 72 (32%) were identified as being at risk of malnutrition and 64 (28.4%) met the inclusion criteria and were randomized (31 in the intervention group and 33 in the control group). There were no significant differences between the groups in terms of all-cause mortality or time to first HF hospitalisation (HR = 0.34 [0.11–1.09]; p = 0.072). At 12 months, the intervention group demonstrated a significant improvement in functional capacity, with an increase of 31.3 metres in the 6-minute walk test (6MWT) (p = 0.002), whereas no significant change was observed in the control group. Nutritional status improved significantly in the intervention group (MNA score +4.12, p < 0.001) and declined in the control group (−1.15, p = 0.029). At 12 months, body mass index, tricipital skinfold thickness, arm circumference, and serum albumin levels increased in the intervention group. Conclusions: A structured and individualised nutritional intervention significantly improved nutritional status and functional capacity over 12 months, although it did not impact major clinical outcomes.

Heart failure remains one of the leading causes of hospital admissions and mortality worldwide, with substantial regional disparities in clinical outcomes. These variations have been linked to differences in socioeconomic conditions, health determinants, and health-care system organisation. The aim of this study was to analyse regional differences in hospitalisation rates and in-hospital mortality for heart failure across Spain’s autonomous communities, and to examine their associations with hospital characteristics and regional health determinants. We conducted a nationwide, retrospective, population-based study using Spain’s national hospital discharge database (Conjunto Mínimo Básico de Datos, CMBD) to identify adults (≥18 years) discharged from public general hospitals within the Spanish National Health System (SNS) with a primary diagnosis of heart failure from January 1, 2016, to December 31, 2022. Differences in hospitalisation rates and risk-standardised in-hospital mortality between autonomous communities were analysed, along with associations with hospital characteristics and regional health determinants. A total of 764,083 hospitalisations for heart failure were analysed. The mean age of participants was 80.8 ± 10.6 years. The age- and sex-standardised hospitalisation rate was 255 per 100,000 inhabitants, with significant differences between autonomous communities. Crude in-hospital mortality rate was 11.3% (86,426 episodes), with substantial regional variation in risk-standardised mortality rate (ranged from 7.7% to 16.4%) No associations were found between hospital characteristics and risk-standardised mortality rate at the regional level. Regional health determinants were highly collinear; among all determinants assessed, per-capita gross domestic product was independently associated with lower risk-standardised mortality (βGDP_pc = −0.77; 95% CI: −1.04 to −0.49; p < 0.001; R2 = 0.77). Significant regional differences in hospitalisation rates and risk-standardised mortality rates were observed among patients hospitalised for heart failure. Regional disparities in gross domestic product per capita may partly explain these differences. These results have clinical and policy implications, underscoring the need to consider socioeconomic determinants when analysing health outcomes and designing public policies aimed at reducing health inequalities. Our findings might be relevant to other European countries with similar public health systems. This work was supported by the 10.13039/100009664 Spanish Society of Cardiology (Sociedad Española de Cardiología, SEC).

Population aging has shifted the burden of cardiovascular disease toward older adults living with multimorbidity, frailty, cognitive vulnerability, functional impairment, and treatment burden. Yet much of the contemporary cardiovascular evidence still derives from randomized clinical trials (RCTs) designed around biologically homogeneous participants, limiting applicability to real-world geriatric cardiology. Our objective was to perform a comparative methodological analysis of two contemporary European cardiovascular RCTs, HI-COR-65 and SENEKA, as illustrative cases and to propose a geriatric-oriented framework for improving trial design in older adults with cardiovascular multimorbidity. We qualitatively compared both trials across five domains: population representativeness, clinical objectives and outcome hierarchy, exclusion criteria, multidisciplinarity, and patient perspective, including participation burden and patient-reported outcomes. Both trials represent important progress by explicitly enrolling older adults with clinically relevant cardiovascular multimorbidity. However, the analysis identified recurring limitations: geriatric complexity is acknowledged but not operationalized through comprehensive geriatric assessment or vulnerability-based stratification; safety and participation requirements may preferentially select robust older adults; outcome hierarchies remain variably aligned with patient priorities; and intervention models are predominantly pharmacological and monodisciplinary. Future cardiovascular trials in older adults should move from chronological inclusion toward pragmatic, complexity-sensitive design. We propose the Comprehensive Geriatric Cardiology (COMGERCARDIO) framework, which integrates baseline geriatric assessment, vulnerability-adaptive interventions, hierarchical patient-centered outcomes, stratified analysis, and implementation evaluation to generate evidence that is scientifically robust, clinically usable, and equitable for aging populations.

Hyperkalemia is an electrolyte disorder characterized by elevated serum potassium levels, which can be dangerous and lead to severe cardiac complications. This condition is particularly common in patients with comorbidities such as diabetes mellitus, chronic kidney disease, heart failure, and hypertension, among others. Additionally, hyperkalemia frequently develops in patients treated concurrently with certain medications, especially renin-angiotensin-aldosterone system inhibitors, which are commonly used to manage cardiac and nephrological conditions, significantly increasing the risk of hospitalizations and mortality in these patients. This review aims to identify key challenges in the management of hyperkalemia, including improving early detection, optimizing access to appropriate therapies, ensuring continuous monitoring, and establishing effective strategies to manage complications. Furthermore, it is essential to raise awareness of its significance and promote a multidisciplinary approach to enhance health outcomes and the quality of life of patients with hyperkalemia.