Every readmission for heart failure is a signal that something has not been fixed. In this masterclass we cover recurrent and worsening heart failure from end to end: the definition of a worsening HF event and the HFrEF, HFmrEF, HFpEF and HFimpEF categories; a systematic search for precipitants (non-adherence, ischaemia, arrhythmia, hypertension, infection, renal dysfunction, harmful drugs, valve disease and under-treatment); diagnosis with clinical congestion and perfusion profiles, NT-proBNP trends, echocardiography, lung ultrasound, VExUS and cardiac MRI, including when to suspect ATTR amyloid; complete decongestion with adequately dosed IV loop diuretics, natriuresis-guided therapy and sequential nephron blockade (DOSE, PUSH-AHF, ADVOR, CLOROTIC); why a modest creatinine rise should not stop decongestion; the four pillars for HFrEF started in hospital and rapidly up-titrated (PARADIGM-HF, PIONEER-HF, DAPA-HF, EMPEROR-Reduced, EMPULSE, SOLOIST-WHF, STRONG-HF); vericiguat, ivabradine, digoxin and intravenous iron (VICTORIA, SHIFT, AFFIRM-AHF, IRONMAN); managing hyperkalaemia and low blood pressure; HFpEF therapy with SGLT2 inhibitors, finerenone and GLP-1–based therapy (EMPEROR-Preserved, DELIVER, FINEARTS-HF, STEP-HFpEF, SUMMIT); devices and interventions (CRT, ICD, CASTLE-AF, CASTLE-HTx, COAPT, STICH, REVIVED-BCIS2); remote monitoring (CHAMPION, GUIDE-HF, TIM-HF2); a safe transition home, salt and fluid advice (SODIUM-HF, FRESH-UP); realistic care in resource-limited settings (TRANSFORM-HF); recognising advanced heart failure with I NEED HELP; and palliative care — illustrated with a worked case.

Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors.
Host: Alexander Wood

Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart.

Learn more:
• Cardiology books: https://cardiologybooks.com
• Mentorship with the Academy of Elite Doctors: https://academyofelitedoctors.com
• Online cardiology courses: https://cardiologycourse.com
• World Elite Doctors: https://worldelitedoctors.com

For medical education only. This episode is not a substitute for individual medical advice.