heart failure

And it is not just heart attacks.

An older Cochrane review covering thirty-nine trials found no effect on all-cause mortality, heart failure, or stroke.

In heart failure with reduced pumping function specifically, a trial showed no reduction in death or hospitalization, even though inflammatory markers went down.

That is a clean demonstration that lowering a number on a lab report is not the same thing as helping a patient feel better or live longer.

Colchicine also failed to prevent re-narrowing of arteries after angioplasty, and repeated meta-analyses have failed to show any reduction in atrial fibrillation.

If you do not have established cardiovascular disease, there is essentially no evidence to support taking colchicine for prevention.

Skip it.

If you have heart failure, there is no evidence it helps, and it does not seem to matter that it lowers inflammation on paper.

And yet, as cool as science is, I have noticed that in my field of hospital medicine, we have a lot of inertia.

and when things are shown with studies it takes a long time to change habits it takes a long time to change order sets it takes a long time for people to stop old practices even though there is data that what they are doing is wrong so i am going to use three examples that you likely see every week in the hospital two will be with heart failure one will be with diabetes of things we simply for whatever reason cannot change because they are quote standard of care end quote even though they are the wrong care And so this doesn't sound like an opinion piece, let me start with a quote from the Journal of Hospital Medicine in February of 2026, where it says, trials comparing dietary salt restrictions in patients hospitalized with acute heart failure showed no improvement in outcomes for those randomized to lower salt targets.

outpatient heart failure data also fails to show a reduction in heart failure admissions and mortality with salt restrictions.

And that's the end of the quote.

But let's look specifically what we're really talking about with low salt diets for acute heart failure.

What have trials shown us? That there's no difference in weight.

They've shown us there's no difference in congestion and there's no difference in readmission for heart failure.

So there's no improvement in outcomes.

[laughs]

So I'm gonna talk about the ketogenic diet in the management of heart failure.

In terms of a very brief outline, I'm gonna touch briefly why I'm here, why I've chosen to research this, a little bit about heart failure, um, the current management of heart failure, and then I'll touch on the trial itself.

The trial's currently recruiting, so I don't have results for you, but we'll talk about when they'll be anticipated.

So I'm am an interventional cardiologist.

Um, and so part of my role at Westmead and the University of Sydney is at the Westmead Applied Research Center, and that's a photo of, um, part of our group there.

And we're an impact center of the University of Sydney, and we do a lot of clinical trials.

So a little bit about heart failure.

Before we begin today's show on heart failure with Dr. Eamon O'Shea, listeners might like to know that Eamon has been working on a heart failure general practice update or GPU with Professor Kenneth MacDonald, which is scheduled for publication in the coming weeks.

As usual, the GPU is designed with the busy clinician in mind and offers up-to-date evidence-based information in a quick reference digital format for ease of access on your desktop or phone.

Areas covered in the Heart Failure GPU include classification, clinical features, investigations, initial treatment and CDM considerations.

And I hope you find today's episode to be a useful companion piece to the new GPU.

Members will be able to download the Heart Failure GPU from the College website soon and I'll include a link to the relevant webpage in the show notes to today's episode.

Thanks!

This podcast is intended for medical professionals and was recorded in winter 25.

It does not replace clinical judgment and always check current clinical guidelines for best practice.

This is one of those meetings where you can feel the field shifting in real time.

Today, we're going to focus first on the major electrophysiology stories, and then we'll move into a rapid fire section covering the new heart failure guidelines, the fifth universal definition of myocardial infarction, nicotine and cardiovascular disease, and the AI mammogram signal.

What makes this meeting so interesting is that several of these presentations challenge old thresholds and old ways of thinking.

In other words, this is not just about new data.

If you want the more granular numbers, including the primary endpoint event rates, the sudden cardiac death breakdown, and the age subgroup statistics, I'd strongly point you to the full EP Edge Journal Watch newsletter.

From there, the conversation broadens.

Because the very same ESC meeting that gave us CMR Guide also gave us a major redefinition of heart failure.

Let's move now to the 2026 ESC Heart Failure Guidelines.

Welcome to Heart Failure Unfiltered.

My name is Nick Hartzorn-Evans, and I'm the founder and CEO of the Pumping Marvelous Foundation, the UK's heart failure charity.

Today, we'll be discussing when we got dad back.

This is the second episode in a series of two podcasts talking to the person who was diagnosed with heart failure and the impact of their heart failure diagnosis on their family.

Receiving a diagnosis is only the beginning.

The family unit shares what really happened for the first time.

This podcast asks one question over and over again.

Beat the diagnosis.

My name's Dana Miller.

I'm a heart failure nurse practitioner.

I specialize in amyloid patients, primarily cardiac ATTR amyloid patients, and we also see AL amyloid patients who have cardiac involvement.

I work at the University of Kansas Health System.

there's no placebo in that trial.

There's two other trials that have some information about the importance of early diagnosis.

There was a recent trial called the Long-Term Clinical Benefits of Acaramidis in Patients with Transthyretin Cardiomyopathy and Early Heart Failure Severity and Survival Benefits Regardless of Atrial Fibrillation or Status.

This study was looking at patients with ATTR amyloidosis early, so New York Heart Association functional class 1 or class 2, and looking at whether achirhamidus would reduce the likelihood of atrial fibrillation or atrial flutter.