Background/Objectives: Cardiac resynchronization therapy (CRT) and angiotensin receptor–neprilysin inhibitors (ARNIs) are cornerstone therapies for patients with heart failure with reduced ejection fraction (HFrEF). However, nearly 30% of patients show no significant response to CRT alone. The potential of ARNI to enhance CRT outcomes—especially in non-responders—is an emerging field of interest. The objective of this review is to systematically evaluate and synthesize the available evidence on the clinical outcomes of combining CRT with ARNI therapy in patients with HFrEF. Methods: We conducted a comprehensive search of PubMed, Scopus, and Google Scholar up to September 2024, using the keywords “CRT and ARNI” and “cardiac resynchronization therapy and sacubitril/valsartan”. We included retrospective and prospective clinical studies, observational studies, and review articles reporting on patients with HFrEF treated with both CRT and ARNI. Studies not in English, animal studies, and those without full-text availability were excluded. Study selection and data extraction were performed in duplicate by independent reviewers, using PRISMA guidelines for transparency. The final selection included 8 studies published in the last four years, summarized by design, population, outcomes, and statistical significance. Results: The reviewed studies suggest that ARNI therapy, when combined with CRT, may contribute to improvements in left ventricle ejection fraction (LVEF), NYHA functional class, and ventricular remodeling, particularly in CRT non-responders. Some studies also report a potential reduction in ventricular arrhythmias and implantable cardioverter-defibrillator (ICD) interventions. However, outcomes varied across subgroups, and the influence of ARNI timing relative to CRT implantation remains inconclusive. Limitations: Heterogeneity in study designs and small sample sizes in some included studies limited the ability to conduct a meta-analysis. This review is not registered. Conclusions: ARNI therapy shows promise in enhancing CRT response in patients with HFrEF, particularly in non-responders. Further large-scale, prospective studies are needed to clarify optimal patient selection and treatment sequencing.

This review aims to summarize the global prevalence of healthcare-associated infections in patients with acute heart failure who have been admitted to coronary care units, highlighting the underrepresented burden of infection in this high-risk population. Coronary care units (CCUs) play a pivotal role in the care of patients experiencing acute or decompensated heart failure, offering a highly monitored environment with immediate access to advanced cardiac interventions. The management of heart failure in CCUs involves a multidisciplinary approach that includes hemodynamic monitoring, pharmacologic therapy, respiratory support, and, in selected cases, mechanical circulatory assistance. The early identification of deterioration, rapid therapeutic escalation, and close monitoring of cardiac function are hallmarks of CCU care. However, the complexity and severity of illness in this population are compounded by a high risk of infections, including hospital-acquired pneumonia, bloodstream infections, and device-related infections. These infections not only increase morbidity and prolong hospitalization but also significantly impact mortality and healthcare costs. The immunocompromised state of many heart failure patients—due to poor perfusion, malnutrition, and the use of invasive devices—further elevates their vulnerability. Effective infection prevention, early diagnosis, and targeted antimicrobial therapy are, therefore, critical components of heart failure management within CCUs. This intersection of advanced cardiac care and infection control highlights the need for integrated, multidisciplinary strategies to improve outcomes in this high-risk population.

Heart failure with reduced ejection fraction (HFrEF) continues to impose a high burden of morbidity and mortality despite significant advances in pharmacologic and device-based therapy. Cardiac resynchronization therapy (CRT) and angiotensin receptor–neprilysin inhibitors (ARNIs) have independently demonstrated substantial benefits in symptoms, health-related quality of life (HRQoL), and survival. Cardiac rehabilitation (CR), incorporating structured exercise, education, and lifestyle optimization, is well established as an effective intervention in HFrEF, yet its role in the era of combined CRT and ARNI therapy remains insufficiently characterized. This literature review synthesizes current evidence on CR in HFrEF populations receiving CRT, ARNI, or both, highlighting its impact on HRQoL, exercise capacity, and functional outcomes. Across diverse study designs—including randomized trials, observational cohorts, and meta-analyses—CR consistently yielded clinically meaningful improvements in patient-reported HRQoL and objective measures such as six-minute walk distance (6MWD) and peak oxygen uptake. Data directly evaluating CR in patients concurrently receiving both CRT and ARNI are lacking; indirect evidence suggests CR is compatible with, and may add to, contemporary device and drug therapy. However, referral rates remain low, indicating an implementation gap despite strong evidence of benefit. The review underscores the importance of integrating CR into contemporary HFrEF care and identifies a pressing need for targeted prospective studies to define its role in patients receiving dual device–pharmacologic therapy.

Background/Objectives: Cardiac resynchronization therapy (CRT) is a cornerstone treatment for heart failure with reduced ejection fraction (HFrEF), yet many patients remain symptomatic despite long-term electrical optimization. Although sacubitril/valsartan (ARNI) is central to guideline-directed medical therapy (GDMT), data on its late initiation in patients with chronic CRT are scarce. This study evaluated the impact of delayed ARNI initiation on clinical status, functional capacity, and cardiac remodelling in a real-world CRT population. Methods: We performed a single-centre, retrospective observational study including 76 HFrEF patients with chronic CRT who started ARNI between 2022 and late 2024. Patients underwent standardized assessment at baseline (T0) and after 12 ± 3 months (T1), including clinical evaluation, 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12), symptom-limited bicycle exercise testing, and comprehensive echocardiography. The primary endpoint was change in quality of life (QoL). Secondary endpoints included exercise capacity, echocardiographic reverse remodelling, NYHA class, loop diuretic dose, and device-detected arrhythmias. Dose–response and multidimensional response patterns were explored. Results: KCCQ-12 increased from 52.96 ± 16.33 to 75.55 ± 18.12 (Δ +22.59 ± 13.22, p < 0.001), with 89.5% achieving a clinically meaningful improvement. Exercise duration and peak workload improved significantly. LVEF increased from 35.08 ± 6.96% to 43.18 ± 8.42% (Δ +8.11%, p < 0.001), with reductions in left ventricular and atrial volumes. Loop diuretic dose decreased (median −10 mg/day furosemide equivalent, p < 0.001), and 26.3% discontinued diuretics. A lower prevalence of device-detected arrhythmias was observed at follow-up, from 34.2% to 6.6% (p < 0.001). Higher ARNI doses were associated with greater likelihood of clinical, functional, and structural response. Longer CRT duration reduced the probability of structural remodelling but not symptomatic or functional benefit. Conclusions: In patients with long-standing CRT, delayed ARNI initiation was associated with improvements in QoL, exercise capacity, cardiac remodelling, congestion status, and electrical stability. These findings suggest that CRT is not a therapeutic ceiling and that late ARNI initiation remains a valuable component of comprehensive GDMT.

Background: Sleep quality (SQ) and physical activity (PA) are among the strongest behavioral determinants of healthy aging, while dietary behavior and psychological factors act as complementary modulators of these relationships. Although each domain has been studied extensively, their combined influence on subjective life expectancy (SLE)—an individual’s perceived likelihood of living to an advanced age—remains largely unexplored. Methods: This narrative review synthesizes evidence from sleep science, exercise physiology, behavioral medicine, and psychological aging. Literature published between January 2015 and 15 December 2025 was examined across PubMed, Scopus, and Web of Science using integrative keyword strategies. Studies addressing SQ, PA, circadian rhythms, psychological health, SLE, or aging-related outcomes were included. Results: The review identifies several converging pathways linking sleep and PA to aging trajectories. Sleep architecture, circadian stability, metabolic regulation, inflammatory balance, and autonomic function represent key biological mechanisms. PA contributes through improvements in mitochondrial efficiency, VO₂max, muscle metabolism, and anti-inflammatory signaling (IL-6 as a myokine). Across studies, both sleep and PA strongly influence psychological health, health perception, and future-oriented expectations, within a broader lifestyle context supported by nutritional status and dietary quality. SLE emerges as a central psychological mediator that shapes motivation, adherence to health behaviors, and long-term health outcomes. Contextual moderators—including age, gender, socioeconomic status, cultural norms, and wearable technology engagement—further influence these relationships. Conclusions: SQ and PA form the core behavioral components of a dynamic system that is further shaped by dietary behavior and psychological well-being and centered on SLE. Our proposed integrative model positions SLE as a key psychological link between lifestyle behaviors and longevity. This framework is hypothesis-generating and requires empirical validation through future longitudinal and interventional studies, underscoring the need for multidomain research integrating behavioral, biological, nutritional and psychological indicators of aging.

Background/Objectives: Healthcare-associated infections (HAIs) remain an important cause of morbidity in coronary care units (CCUs). Although left ventricular ejection fraction (LVEF) is central to cardiovascular risk stratification, its relationship with infection susceptibility in CCU patients is poorly defined. We explored the association between LVEF and HAI incidence in a real-world CCU population. Methods: We performed a retrospective cohort study including 870 consecutive adult patients admitted to a tertiary CCU. Patients were stratified by LVEF into reduced (<40%) and preserved or mildly reduced (≥40%) groups. HAIs were defined using Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN) criteria and required microbiological confirmation. Demographic data, comorbidities, exposure to invasive devices, colonization status and clinical outcomes were collected. Associations with HAIs were assessed using univariate and exploratory multivariable logistic regression. Results: Of the 870 patients, 235 (27.0%) had LVEF < 40%. The overall HAI incidence was 1.8% (16/870) and was significantly higher in patients with reduced LVEF compared with those with LVEF ≥ 40% (3.82% vs. 1.10%, p = 0.018). Patients with LVEF < 40% had greater exposure to invasive devices (OR 2.06, 95% CI 1.52–2.79, p < 0.001). The excess HAI burden was mainly driven by urinary tract infections (1.70% vs. 0.15%, p = 0.021). Colonization rates at admission were similar between groups. In univariate analysis, reduced LVEF was associated with higher HAI occurrence, but it did not remain independently associated after adjustment. Admission infection, malignancy, CPAP use, and CCU length of stay ≥5 days emerged as independent factors in the exploratory multivariable model (Nagelkerke R² = 0.247). Conclusions: Reduced LVEF is associated with higher HAI incidence in CCU patients, reflecting greater clinical severity, longer hospitalization, and increased exposure to invasive devices. Although not an independent predictor, LVEF appears to function as a clinically useful marker of vulnerability that may support early risk stratification and targeted infection-prevention strategies in CCU settings.