Heart Failure Trials ⚖️ Therapies 💊 FDA Decisions 📜

🚨 New in JACC (Aug 2025): Evidentiary Landscape of HF Therapies 🫀   Over the last decade, the heart failure field has shifted from the "mortality reduction era" (ACEIs, β-blockers, MRAs) ➡️ to the "hospitalization reduction era" (SGLT2i, ARNI in HFpEF, iron therapy).   🔑 Key Insights: ⚖️ FDA decisions reflect both rigor and flexibility — approving sacubitril/valsartan in HFpEF despite a missed primary endpoint, while rejecting omecamtiv mecarbil despite statistical significance. 🧬 Enrichment strategies (NT-proBNP, iron indices, recent WHF) drive modern trial design, boosting efficiency but limiting mortality signals. 📊 Composite endpoints (CV death + HHF) dominate, making hospitalization reduction the most reproducible outcome. 📖 Guidelines now anchor on ARNI + SGLT2i in HFrEF and SGLT2i in HFpEF, with emerging roles for finerenone and incretin-based therapies.   👉 Big picture: Clinical practice is evolving, but the "holy grail" of new mortality-reducing therapies remains elusive.   #HeartFailure #Cardiology #ClinicalTrials #FDA #JACC