30-Second Takeaway
- 2026 ACC/AHA dyslipidemia guideline broadens focus to triglycerides and Lp(a), updating ASCVD prevention algorithms.
- Conflicting CRT trials demand nuanced selection between conduction system and biventricular pacing in HFrEF with LBBB.
- Real-world data show higher-dose, rapidly optimized HF GDMT lowers mortality yet remains rarely achieved and poorly sustained.
- Registry signals suggest β‑blockers may harm HFpEF without AF or ischemic disease, challenging habitual prescribing.
- Wearables, telemedicine, and HF risk prediction tools offer pragmatic ways to reduce events in AF and ASCVD populations.
Week ending March 14, 2026
HF therapeutics, CRT strategies, dyslipidemia guidance, and AF care models: tightening the evidence–practice gap
2026 ACC/AHA dyslipidemia guideline expands beyond LDL-C
This guideline fully retires and replaces the 2018 ACC/AHA cholesterol guideline. It addresses evaluation, treatment, and monitoring of high LDL-C, hypertriglyceridemia, and elevated lipoprotein(a). Evidence through December 2024 from major databases underpins updated recommendations across primary and secondary prevention. Clinicians should anticipate revised risk assessment, broader lipid targets, and incorporation of newer lipid-lowering options into routine care.
PhysioSync-HF: CSP inferior to BiV CRT at 12 months
PhysioSync-HF randomized 173 patients with NYHA II–III HFrEF, LVEF ≤35%, and LBBB to conduction system pacing or biventricular pacing. CSP was inferior to BiV pacing for the hierarchical composite of death, HF hospitalizations, urgent HF visits, and LVEF change (OR 2.36). The time-to-event composite of death, HF hospitalizations, or urgent HF visits numerically favored BiV pacing. LVEF improvement was greater with BiV pacing, although functional status and biomarkers improved similarly in both groups. CSP generated substantially lower direct medical costs, but at the expense of worse HF-related outcomes.
HeartSync-LBBP: LBB pacing improves 3-year HF outcomes vs BiV CRT
HeartSync-LBBP randomized 200 patients with LVEF ≤35% and LBBB at six Chinese centers to left bundle-branch pacing or biventricular pacing. Over a median 36-month follow-up, LBBP reduced death or HF hospitalization versus BiV pacing (8% vs 28%; HR 0.26). HF hospitalization was markedly lower with LBBP, while all-cause mortality alone was similar between groups. Echocardiographic response was high in both arms, but super-response was more frequent with LBBP (55% vs 36%). High implant success in both strategies supports LBBP as an effective CRT alternative in appropriate HFrEF patients.
EMPACE: quadruple HF GDMT is rare and slow to start
EMPACE analyzed 17,210 US patients hospitalized for HF between 2020 and 2023 using claims-based data. Among HFrEF patients, only 1% were on quadruple therapy before hospitalization and 2% after discharge. Post-discharge use of individual classes improved modestly, but ARNI and SGLT2 inhibitors remained substantially underused. Time to initiation was longest for SGLT2 inhibitors and quadruple therapy, often months after index hospitalization. Twelve-month discontinuation rates were high, especially for ARNI and mineralocorticoid receptor antagonists, indicating fragile persistence. Similar underuse and delays were observed for SGLT2 inhibitors in HFmrEF and HFpEF despite contemporary guideline support.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.