What is the reason for and aim of the publication?
Heart failure (HF) remains a major cause of morbidity, mortality and healthcare expenditure, yet prevention has received less attention than treatment after HF has developed. Since the 2022 HFA/EAPC position paper, important evidence has emerged. The main aim of our scientific statement is to collect and synthesize the available evidence on the primary prevention of both HF with reduced ejection fraction and HF with preserved ejection fraction, considering conventional risk factors, such as hypertension, diabetes, chronic kidney disease and obesity, alongside less conventional and emerging determinants, including female-specific risk factors, infections, cancer therapies, air pollution and socioeconomic conditions. The statement also provides a practical framework to identify individuals at increased risk and to combine risk assessment, lifestyle measures and evidence-based preventive treatments.
What are the most important take-home messages?
- HF is often preventable. The greatest opportunity lies in identifying and treating high-risk individuals before symptoms appear.
- Risk should be assessed holistically. Hypertension, diabetes, chronic kidney disease and obesity frequently cluster within the cardiovascular-kidney-metabolic syndrome, while female-specific factors, infections, air pollution and socioeconomic conditions also matter.
- Prevention requires both lifestyle measures and evidence-based pharmacotherapy. Blood-pressure control, physical activity, weight management and smoking cessation should be combined with therapies that reduce HF risk.
- Validated HF-risk models and selected biomarkers can guide targeted prevention.
What are the challenges in practical implementation – and possible solutions?
The main challenge is to identify individuals at highest risk before symptoms or structural heart disease develop. HF results from heterogeneous and frequently coexisting conventional and non-conventional risk factors, whose relative contribution varies across patients and HF phenotypes. In addition, the evidence supporting preventive interventions remains uneven, and no universally accepted strategy defines whom to screen, how, or at what intervals. Practical implementation therefore requires an individualized approach combining assessment of conventional and emerging risk factors, validated risk scores and biomarkers when appropriate, and early treatment of modifiable conditions. Multidisciplinary collaboration can translate this multidimensional assessment into tailored prevention, while further studies define the most effective and sustainable screening strategies.
Which issues still need to be tackled that are not yet addressed by the paper?
Several questions require dedicated prospective research. We still lack validated models that predict HFpEF and HFrEF separately and robust evidence defining whom to screen, at what intervals, and with which combination of biomarkers and imaging. The cost-effectiveness, scalability and effects of screening on quality of life and mortality also remain uncertain. Trials should evaluate incident HF as a primary endpoint, include patients with severe kidney disease and under-represented populations, and determine whether interventions can reduce the excess risk associated with reproductive factors, air pollution, sleep-disordered breathing and socioeconomic disadvantage. Implementation research is also needed to show how effective strategies can be delivered equitably across different healthcare systems.
What further developments on the topic are emerging?
HF prevention is moving towards earlier, phenotype-aware and more personalized intervention. The cardiovascular-kidney-metabolic framework is encouraging integrated assessment of obesity, diabetes and kidney disease rather than a single-risk-factor approach. HF-specific prediction tools combined with natriuretic peptides, albuminuria, high-sensitivity troponin and selected imaging may enable more efficient targeted screening. Therapeutically, the preventive roles of SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists and GLP-1 receptor agonists are expanding. Important next steps include testing whether these approaches are additive, determining whether modern obesity treatments prevent incident HF, and integrating environmental, socioeconomic and female-specific risk into both research and routine risk assessment.
Prevention of heart failure
Massimo Piepoli, Giuseppe Rosano, Ana Abreu et al. Prevention of heart failure: A scientific statement of the Heart Failure Association, the European Association of Preventive Cardiology, and the Association of Cardiovascular Nursing & Allied Professions of the ESC, and the ESC Council on Hypertension, European Heart Journal, 2026; ehag362. https://doi.org/10.1093/eurheartj/ehag362
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