The selection of patients eligible for implantable cardioverter defibrillator (ICD), in primary prevention, is a critical moment in the management of the patients with cardiomyopathies as it needs a right balance of the patients’ arrhythmic risk and the risks related to the implantation, as well as the device costs. Several data indicate that left ventricular ejection fraction alone is not a sufficient criterion for a proper identification of patients who could benefit most from ICD. Numerous findings show that genetic analysis and characterization of myocardial fibrosis with magnetic resonance imaging allow an important improvement of this process.

Heart failure (HF) is a condition with a high clinical and healthcare burden. In Europe, the current incidence is approximately 5 per 1000 persons per year in the adult population, with a prevalence of 1–2%. Prognosis remains poor, with persistently high rates of mortality and hospitalization. The period immediately following hospital discharge is known as the “vulnerable phase,” marked by a heightened incidence of clinical events, including a 30% chance of rehospitalization and a 10% mortality risk. Effective patient management during this time is crucial and should incorporate a risk stratification process, which is vital for designing a personalized follow-up plan and ensuring optimal resource utilization. This review aims to outline the available tools for prognostic risk stratification and propose a structured follow-up model applicable at discharge from an HF hospitalization in patients with HF with reduced ejection fraction and in patients with mildly reduced/preserved ejection fraction.

Background: Heart failure (HF) remains a major cause of morbidity, mortality, and healthcare resource utilisation, requiring integrated multidisciplinary care across hospital and community settings. This study aimed to describe the organisation of HF care and post-discharge management in Italy through two complementary national surveys promoted by the Italian Association of Hospital Cardiologists (ANMCO). Methods: Two complementary cross-sectional organisational surveys were conducted to describe the organisation of HF care in Italy. The Regioni 3.0 survey, performed between November 2023 and September 2024, collected 196 responses from directors of cardiology departments and HF Centers regarding organisational resources, post-discharge follow-up pathways, and integration with community healthcare services. A second survey, administered during the ANMCO Heart Failure Centers Convention in October 2024, collected 135 responses on discharge planning and outpatient follow-up practices. Results: HF outpatient clinics were available in 85.7% of Centers, whereas only 42.6% reported non-physician staff specifically assigned to HF care. Structured post-discharge follow-up pathways were reported by 91.3% of Centers, but functional links with primary care or community healthcare services were present in only 47.7%. Medication reconciliation and patient education were routinely performed in most Centers, whereas telemonitoring systems were available in approximately one-third of respondents. Conclusions: HF care in Italy is supported by a widespread network of outpatient clinics and structured post-discharge follow-up pathways. However, important organizational gaps remain in multidisciplinary staffing, hospital–community integration, and telemonitoring, highlighting the need to strengthen multidisciplinary resources, improve hospital–community integration, and expand telemonitoring to support more coordinated HF care nationwide.

Mineralocorticoid receptor antagonism represents a therapeutic cornerstone in patients with HFrEF. However, the efficacy of MRAs in patients HFmrEF or HFpEF remains unclear. While the TOPCAT trial did not demonstrate a statistically significant reduction in cardiovascular mortality or hospitalizations for HF in this patient population, post hoc data suggested potential clinical benefits of MRAs in specific patient subgroups. More recently, the landscape has evolved with the FINEARTS-HF trial, which generated novel evidence regarding finerenone, a non-steroidal MRA, in the HFmrEF and HFpEF cohorts. This investigation established a statistically significant decrease in the primary composite endpoint, comprising cardiovascular death and worsening heart failure events. This positive outcome was principally attributable to a lower incidence of total WHF events. Key findings also highlighted the therapy’s rapid onset of action and favorable safety profile. Notably, finerenone’s benefit was consistent across the entire LVEF spectrum and was not influenced by baseline SGLT2i use, sex, or age. Finerenone’s established indication is for patients with type 2 diabetes mellitus and chronic kidney disease to reduce heart failure risk. However, based on the findings of the FINEARTS-HF trial, finerenone may represent a novel therapeutic pillar for patients with HFpEF and HFmrEF. In this review, we aim to describe the potential benefits of MRAs in the pathophysiology of HFpEF and HFmrEF and in different patient phenotypes, the results of the FINEARTS-HF trial, and the most important subanalyses of the study.