Comprehensive update on heart failure and cardiomyopathies: from epidemiology to mechanisms and management

For the podcast associated with this article, please visit https://academic.oup.com/eurheartj/pages/Podcasts. The issue opens with a contribution entitled ‘The role of cardiovascular disease journals in reporting sex and gender in research’ by C. Noel Bairey Merz from Cedars-Sinai Medical Center in Los Angeles, CA, USA, and colleagues which provides a comprehensive discussion on the changes needed to respond to the historical under-representation of women in clinical trials and to the inattention to sex as a biological variable.1 The authors note that without such changes, prevention, diagnosis, and treatment in women are substantially compromised. The issue continues with a focus on heart failure (HF) and cardiomyopathies. Heart failure and atrial fibrillation (AF) are closely intertwined, and the occurrence of AF in patients with chronic HF is related to worse prognosis, especially mortality and stroke.2–5 A Great Debate article entitled ‘Great debate: ablation of atrial fibrillation should be performed in patients with heart failure with reduced ejection fraction’ by Johann Bauersachs from Hannover Medical School in Germany, discusses whether ablation of atrial fibrillation should be systematically performed in patients with HF with reduced ejection fraction (HFrEF).6 Whether a reduction of AF burden may improve not only symptoms but also prognosis in HFrEF is still a matter of debate, as the respective studies to date have not been fully conclusive. Obtaining informed consent from the patient also needs discussion of potential risks of the ablation procedure, although major complications are rare with modern ablation techniques. Repeated ablation may be necessary in patients with high symptom burden from recurrent/persistent AF following an ablation procedure. Thus, the current Great Debate is timely and important to all cardiologists involved in HFrEF and/or AF treatments: top experts in the field highlight and evaluate all available evidence in their Pro/Con pieces.