Latest developments in heart failure

The Irish Cardiac Society Annual Scientific Meeting and AGM took place in the Great Southern Hotel, Killarney, Co Kerry, on 16–18 October 2025.

The well-attended meeting provided delegates with a wealth of information on the latest developments and best practice in cardiac care.

During the heart failure subgroup meeting, Prof Mark Petrie delivered an insightful talk on “what’s hot in heart failure”.

The Professor of Cardiology, School of Cardiovascular and Metabolic Health, University of Glasgow, Scotland, is considered by his peers to be a world leader in heart failure and has leadership roles in several clinical trials.

Prof Petrie provided an overview on advancements in treating heart failure, along with an update on clinical trials.

He began his talk by discussing inflammation in heart failure with preserved ejection fraction (HFpEF).

He highlighted Walter Paulus’ paradigm that comorbidity-driven inflammation drives HFpEF.

“Inflammation was thought to be responsible for driving the development of heart failure and fuelling it when it happens,” he said.

“With increased imaging, we’ve started to understand how the volume of fat or adipose tissue around the body and things like epicardial adipose tissue and visceral fat [contributes to heart failure]. We could talk for hours about this, but suffice to say this is an extremely ‘hot’ area.”

Prof Petrie spoke about how the NLRP3 inflammasome is activated by comorbidities and, when activated, produces various pro-inflammatory cytokines such as IL-1β.

He noted the HERMES trial, which has enrolled 5,600 patients with HFpEF and HFmrEF (mildly reduced ejection fraction), will be completed in 2027.

It is examining whether or not the anti-inflammatory therapy ziltivekimab, an anti-interleukin-6 (IL-6) antibody, can reduce cardiovascular events.

The large and influential CANTOS trial, which gave rise to more trials and analyses, he said, found that targeting inflammation with the interleukin-1 beta (IL-1β) inhibitor canakinumab reduced cardiovascular events in patients with high inflammation after a myocardial infarction.

“This made people think maybe there is mileage in trying to use anti-inflammatory therapies to improve outcomes and reduce heart failure hospitalisations,” he told the meeting.

“People in CANTOS who achieved a lower CRP [C-reactive protein] did better and had an even larger reduction in heart failure hospitalisation.”

He said that IL-6 has now become a better predictive measure of “bad things happening from a heart failure perspective” in terms of hospitalisations and death.

Ziltivekimab is a subcutaneous drug given once a month. Data for the therapy has shown a big reduction in CRP, by as much as 90 per cent, Prof Petrie stated.

Another hot topic in relation to heart failure, he said, is weight-loss drugs.

He explained that for several years, until recently, there was major concern that both GLP-1 RAs and weight loss were “bad for heart failure”.

“This has been a really difficult area over the years. Seven or eight years ago… groups of us around the world went to some companies and said people with heart failure who are obese have higher bed rates and losing weight on weight-loss drugs will be a good thing. We were told ‘you are [wrong]’, and that people who are heavier have better outcomes and people who are lighter do worse. This thing called the ‘obesity paradox’ was prevalent at the time,” Prof Petrie said.

“Sensible, newer data looking at outcomes in people with heart failure and obesity showed that people who were heavier actually do worse.”

Three trials in this area have now been completed, namely: STEP-HFpEF, STEP-HFpEF DM, and SUMMIT, and have demonstrated positive impacts from weight-loss medication (semaglutide and tirzepatide).

The STEP-HFpEF trial found that obesity is not just a comorbidity in patients with HFpEF, but a root cause and a target for therapeutic intervention.

“In HFpEF we know that patients on these drugs improve quality-of-life and lose weight,” Prof Petrie explained.

Another ongoing trial he is involved in – the MARITIME-HF trial – is investigating the investigational weight-loss drug Maridebart cafraglutide in people with heart failure and obesity, and will be completed in 2030. There are now 400 obesity drugs in development, he added.

Subcutaneous furosemide in heart failure is another emerging area of interest, with trials ongoing.

“We did a phase 1 trial in Glasgow and we showed that the diuretic effect was greater with subcutaneous furosemide…. This opens up a lot of potential opportunities in heart failure,” he said.

Early diagnosis of heart failure is another area garnering a lot of attention, he said, and trials are ongoing, including the SYMPHONY trial, which aims to improve early detection of heart failure in at-risk individuals.

Coronary artery disease in heart failure was another area highlighted by Prof Petrie during his talk.