HFA Cardio Talk

With Floran Sahiti, University Hospital of Wurzburg, Wurzburg - Germany and Marianna Adamo, University and Civil Hospital of Brescia, Brescia – Italy.

This episode discusses the key changes in the 2026 ESC Guidelines for the management of heart failure with Marianna Adamo, one of the Task Force chairpersons.

The conversation explores the rationale for removing HFmrEF as a separate phenotype and grouping all patients with an LVEF below 50% as HFrEF. It also covers the new emphasis on stages A to D and earlier treatment to prevent symptomatic heart failure.

It also examines diagnostic updates, including age-specific NT-proBNP cut-offs and the shift from "acute" to "decompensated" heart failure. Treatment topics include the new framework of foundational, additional and guideline-directed interventional therapies, the place of semaglutide and tirzepatide in obese patients with HFpEF, and the upgrade of LVAD to a Class I recommendation.

Finally, the episode goes behind the scenes of the consensus process, highlighting which recommendations were most debated within the Task Force.

Guideline paper: Kober L, Adamo M, Ruwald AC, et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J. Published online August 28, 2026. doi:10.1093/eurheartj/ehag100

This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsor.

With Gregorio Tersalvi, Mayo Clinic, Rochester, Minnesota - USA, Lars Kober and Jawad Haider Butt, Rigshospitalet - Copenhagen University Hospital, Copenhagen - Denmark, Jolie Bruno, Inselspital, Bern University Hospital, University of Bern, Bern - Switzerland, Jorg Hausleiter, LMU University Hospital, LMU Munich, Munich - Germany, Benedikt Norbert Beer, University Medical Center Hamburg-Eppendorf, Hamburg - Germany, Marianna Adamo, University and Civil Hospital of Brescia, Brescia - Italy and Novi Yanti Sari, Siloam Hospitals Group, Jakarta - Indonesia.

In this episode, we discuss the late-breaking clinical science presented at ESC Congress 2026 in Munich, Germany.

First, Jolie Bruno interviews Lars Kober and Jawad Haider Butt on hydralazine plus isosorbide dinitrate in HFrEF, covering the results of the H-HeFT trial and of the accompanying H-ISDN meta-analysis. H-HeFT compared H-ISDN with placebo in patients with symptomatic heart failure and an ejection fraction of 40% or less, while the meta-analysis pooled three placebo-controlled trials to assess the effect of H-ISDN on mortality and heart failure events.

Next, Benedikt N. Beer interviews Jorg Hausleiter, who highlights the key findings of TRIC-I-HF, a randomised, open-label trial of transcatheter tricuspid valve repair on top of medical therapy versus medical therapy alone in patients with severe tricuspid regurgitation and heart failure.

Finally, Novi Yanti Sari interviews Marianna Adamo, who co-chaired the 2026 ESC Guidelines for the management of heart failure and outlines the main novelties of the document.

This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsor.

Presenter: Gregorio Tersalvi, Mayo Clinic, Rochester, Minnesota - USA

Segment 1:

• Title: H-HeFT: Hydralazine-Isosorbide Dinitrate in HFrEF + H-ISDN Meta-Analysis
• Results paper: not yet published
• Design paper: Wiggers H, Køber L, Gislason G, et al. The DANish randomized, double-blind, placebo controlled trial in patients with chronic HEART failure (DANHEART): A 2 × 2 factorial trial of hydralazine-isosorbide dinitrate in patients with chronic heart failure (H-HeFT) and metformin in patients with chronic heart failure and diabetes or prediabetes (Met-HeFT). Am Heart J. 2021;231:137-146. doi:10.1016/j.ahj.2020.09.020

Segment 2:

• Title: TRIC-I-HF (TRICuspid Intervention in Heart Failure)
• Results paper: Hausleiter J, Stocker TJ, Geisler T, et al. Tricuspid-Valve Intervention in Heart Failure. N Engl J Med. Published online August 30, 2026. doi:10.1056/NEJMoa2606934
• Design paper: Stocker TJ, Geisler T, Rottbauer W, et al. Rationale and design of the TRIC-I-HF-DZHK24 (TRICuspid Intervention in Heart Failure) trial. Eur J Heart Fail. 2025;27(10):1895-1904. doi:10.1002/ejhf.3795

Segment 3:

• Title: Highlights from the 2026 ESC Guidelines for the management of heart failure
• Guideline paper: Køber L, Adamo M, Ruwald AC, et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J. Published online August 28, 2026. doi:10.1093/eurheartj/ehag100

With Daniella Motta Da Costa Dan, Rede Meridional Hospital, Vitoria - Brazil and Linda Van Laake, University Medical Center Utrecht, Utrecht - The Netherlands.

This episode discusses recent progress across the entire heart transplantation journey, from candidate selection to long-term follow-up.

The conversation explores how clinicians should assess increasingly complex transplant candidates, including older or frail patients and those with several comorbidities.

It also examines new strategies to expand the donor pool, with a special focus on donation after circulatory death, extended-criteria donors, hepatitis C-positive donors, machine perfusion and improved donor–recipient matching.

Finally, the episode discusses advances in post-transplant care, including personalized immunosuppression, biomarkers, donor-derived cell-free DNA, gene-expression profiling and non-invasive graft surveillance.

This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsor.

With Cornelia Margineanu, University of Medicine and Pharmacy Carol Davila, Bucharest - Romania and Holger Thiele, Heart Center Leipzig at University of Leipzig, Leipzig - Germany.

In this episode, Cornelia Margineanu interviews Holger Thiele on the practical approach to temporary mechanical circulatory support in heart failure.

Specific examples and clinical scenarios in which temporary mechanical circulatory support (MCS) should be considered, as well as when patients should be referred to tertiary centres, are discussed. The differences between various MCS devices, including their advantages and limitations, are also explored, along with the key elements of patient monitoring.

This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsor.

With Gregorio Sambataro and two patients: Caius and Ulrich.

Gregorio Sambataro of the European Heart Network chats with Caius and Ulrich about their personal experiences with heart disease and their thoughts on the expanding use of artificial intelligence in healthcare. The conversation delves into important themes such as trust in technology and patients' responsibility to actively participate in their own care. It also emphasises the importance of raising awareness among healthcare professionals and the general public, as well as the fact that AI should be utilised as a supplement rather than a replacement for human decision-making.

This 2026 HFA Cardio Talk podcast AI4HF is funded by the European Union's Horizon Europe Framework under Grant Agreement No 101080430.

With Mehitabel Holler and two patients: Sheilagh and Karen.

In this episode, Mehitabel talks with Sheilagh and Karen about their experiences as patients helping to build artificial intelligence tools for heart failure. The discussion touches upon first assumptions and worries about AI (trust, transparency) and the possibility of losing the human element in care. The episode also discusses the need of clinician involvement, evidence gathering, and user-friendly design in building trust in AI-driven healthcare, emphasising that AI should complement the patient-clinician interaction.

This 2026 HFA Cardio Talk podcast AI4HF is funded by the European Union's Horizon Europe Framework under Grant Agreement No 101080430.

With Novi Yanti Sari, Siloam Hospitals Group, Jakarta - Indonesia, Sotiria Liori, National & Kapodistrian University of Athens Medical School, Athens - Greece, Sarah Birkhoelzer, University Dorset Hospital, Bournemouth - UK, Joseph Selvanayagam, Flinders University, Adelaide - Australia, Sam Straw, University of Leeds, Leeds - UK, Ida Arentz Taraldsen, Copenhagen University Hospital, Copenhagen - Denmark, Fabian Kerwagen, University Hospital of Wurzburg, Wurzburg - Germany, Dirk Van Veldhuisen and Kevin Damman, University Medical Centre Groningen, Groningen - The Netherlands.

In this episode, we discuss the late-breaking clinical science presented at the Heart Failure Congress 2026 in Barcelona, Spain.

First, Sarah Birkhoelzer interviews Joseph Selvanayagam, who presents the results of RESOLVE-HCM, a trial evaluating perhexiline for regression of left ventricular hypertrophy in symptomatic hypertrophic cardiomyopathy.

Next, Sam Straw interviews Ida Arentz Taraldsen, who highlights the key findings of REDOX-AHF, a trial comparing restrictive versus liberal oxygenation targets in patients with acute heart failure and pulmonary congestion.

Finally, Fabian Kerwagen interviews Dirk Van Veldhuisen and Kevin Damman, who discuss the DECISION trial and the accompanying meta-analysis. DECISION evaluated low-dose digoxin in patients with heart failure with reduced or mildly reduced ejection fraction, while the meta-analysis assessed the efficacy and safety of digitalis glycosides across contemporary heart failure trials.

This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsor.

With Novi Yanti Sari, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia and Michelle Bloom, NYU Langone Health, New York, USA.

In this episode Novi Yanti Sari speaks with Michelle Bloom about the intersection between cardio-oncology and heart failure. As cancer survival continues to improve, cardiovascular complications especially heart failure related to cancer therapies are increasingly encountered in clinical practice. The discussion explores the burden of heart failure among cancer survivors, mechanisms of cancer therapy-related cardiotoxicity, strategies for early detection and monitoring, management, and the importance of multidisciplinary collaboration between cardiologists and oncologists.

This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsor.

With Giulia Bruno, Hospital Limerick, Limerick - Ireland and Piotr Ponikowski, Wroclaw Medical University, Wroclaw - Poland.

In this episode, Giulia Bruno is joined by Piotr Ponikowski to explore the complex interplay between valvular heart disease and heart failure. As our understanding of secondary mitral and tricuspid regurgitation evolves, new questions are emerging around prognosis, optimal timing of intervention, and the role of transcatheter therapies.

Together, they discuss how to approach management in these patients, the importance of guideline-directed medical therapy, and whether treating the valve can truly improve outcomes. This conversation highlights the challenges, current evidence, and future directions shaping this rapidly evolving field.

Recommended readings:

• 2025 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). https://doi.org/10.1093/eurheartj/ehaf194
• 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. https://doi.org/10.1093/eurheartj/ehad195
• 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. https://doi.org/10.1093/eurheartj/ehab086
• Coats AJ et al. The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the HFA, EACVI, EHRA, and EAPCI of the ESC. European Heart Journal. 2021. https://doi.org/10.1093/eurheartj/ehab086
• Stone GW et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. NEJM. 2018 (COAPT). DOI: 10.1056/NEJMoa1806640
• Stone GW et al. Five-Year Follow-up after Transcatheter Repair of Secondary Mitral Regurgitation. NEJM. 2023. DOI: 10.1056/NEJMoa2300213
• Sorajja P et al. Transcatheter Repair for Patients with Tricuspid Regurgitation. NEJM. 2023 (TRILUMINATE Pivotal). DOI: 10.1056/NEJMoa2300525
• Iliadis C et al. Acute heart failure and valvular heart disease: a scientific statement of the HFA, ACVC and EAPCI of the ESC. European Journal of Heart Failure. 2023. https://doi.org/10.1002/ejhf.70043

This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsor.

With Liemena Harold Adrian, Syarifah Ambami Rato Ebu General Academic Hospital, Surabaya - Indonesia and Shelley Zieroth, St. Boniface Hospital, Winnipeg - Canada.

In this episode, Liemena Harold Adrian and Shelley Zieroth discuss heart failure in post–myocardial infarction patients, covering how myocardial infarction leads to the development of heart failure despite advances in reperfusion and acute care. The conversation addresses the epidemiology and underlying pathophysiology, approaches to early prevention and screening, diagnostic tools, as well as key interventions in the acute and early post-MI phases that may alter heart failure trajectories. They outline management with guideline-directed medical therapy, review current studies on heart failure–modifying therapies (such as the DAPA-MI and EMPACT-MI trials), and address indications for advanced therapies in post-MI populations. The episode also highlights the importance of early diagnosis, prompt recognition, and key evidence gaps in the field.

Recommended readings:

• Akhtar KH, Khan MS, Baron SJ, et al. The Spectrum of Post-Myocardial Infarction Care: From Acute Ischemia to Heart Failurehttps://doi.org/10.1016/j.pcad.2024.01.017. Prog Cardiovasc Dis. (2024); 82: 15-25. DOI: 10.1016/j.pcad.2024.01.017.
• Butler J, Hammonds K, Talha KM, et al. Incident Heart Failure and Recurrent Coronary Events Following Acute Myocardial Infarctionhttps://doi.org/10.1093/eurheartj/ehae885. Eur Heart J (2025); 46: 1540-50. DOI: 10.1093/eurheartj/ehae885.
• Butler J, Jones WS, Udell JA. Empagliflozin after Acute Myocardial Infarction. N Engl J Med (2024); 390: 1455-66. DOI: 10.1056/NEJMoa2314051.
• Fioretti F, Butler J, Udell JA, et al. Empagliflozin after myocardial infarction with or without diabetes and chronic kidney disease: Insights from EMPACT-MI. ESC Heart Failure (2025); 12: 3940-3952. DOI: 10.1002/ehf2.15393.
• Hernandez AF, Udell JA, Jones WS. Effect of Empagliflozin on Heart Failure Outcomes After Acute Myocardial Infarction: Insights From the EMPACT-MI Trial. Circulation (2024); 149: 1627–1638. DOI: 10.1161/CIRCULATIONAHA.124.069217.
• Jenca D, Melenovsky V, Stehlik J, et al. Heart Failure after Myocardial Infarction: Incidence and Predictors. ESC Heart Failure (2021): 8: 222-237. DOI: 10.1002/ehf2.13144.
• Lala A, Beavers C, Blumer V, et al. The Continuum of Prevention and Heart Failure in Cardiovascular Medicine: A Joint Scientific Statement from the Heart Failure Society of America and The American Society for Preventive Cardiology. Journal of Cardiac Failure (2026); 32: 75-105.
• Petrie MC, Udell JA, Anker SD, et al. Empagliflozin in Acute Myocardial Infarction in Patients with and without Type 2 Diabetes: A Pre-specified Analysis of the EMPACT-MI Trial. Eur J of Heart Fail. (2025): 27: 577-588. DOI: 10.1002/ejhf.3548.
• Zieroth S, Rizi SS. Time Is of the Essence. JACC: Heart Failure (2023): 11(6): 713-714. DOI: 10.1016/j.jchf.2023.03.022

"This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsors."