Contemporary heart failure evidence in 2025: a joint summary of key trials from the European Journal of Heart Failure and ESC Heart Failure Journal

Heart failure (HF) remains a major global health challenge, characterized by high morbidity, mortality, and healthcare costs despite substantial advances in pharmacological, device-based, and structural therapies. Its increasing prevalence reflects population ageing, improved survival after myocardial infarction, and the rising burden of cardiometabolic disease, while growing clinical heterogeneity across the ejection fraction spectrum demands more precise diagnostic and therapeutic strategies. This state-of-the-art review summarizes contemporary HF evidence published in the European Journal of Heart Failure and ESC Heart Failure Journal, integrating recent advances in epidemiology, aetiology, diagnostics, and treatment. Emerging data underscore the role of multi-parametric biomarkers, advanced imaging, and artificial intelligence-based tools in enabling earlier diagnosis, refined risk stratification, and personalized management. Aetiology-specific insights-including hypertensive and ischaemic heart disease, cardiomyopathies, amyloidosis, and pregnancy-related HF-are reshaping clinical pathways and therapeutic decision-making. Major developments in guideline-directed medical therapy are reviewed, including early and intensive initiation strategies, expanding evidence for sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists across the spectrum of ejection fraction, and persistent gaps between trial evidence and real-world implementation. Advances in decongestion, cardio-renal interactions, structural valve interventions, and device-based monitoring further illustrate the evolving complexity of HF care. Despite an expanding therapeutic armamentarium, delayed diagnosis, underuse of evidence-based therapies, and organizational barriers continue to limit clinical impact. Bridging this implementation gap through earlier prevention, precision phenotyping, and integrated multidisciplinary care is essential to improving outcomes for HF patients.