Mass General Brigham Investigators Call for Focus on Heart Failure Prevention

Significant strides have been made in treating heart failure, but there remains no cure. Recent advancements in our understanding of risk factors for heart failure, especially obesity, kidney disease, and other conditions, could make prediction and prevention possible. In a series of papers published in The Lancet and simultaneously presented at the European Society of Cardiology Congress 2025 (ESC), investigators from Mass General Brigham call for a shift from focusing on treatment to an emphasis on prevention of heart failure at the global level, offering strategies to reduce the rising burden of this chronic condition worldwide. 

“Heart failure has undergone a renaissance for treatment in the last five years, with the advent of new and emerging therapies. And while these offer hope of management for people with established disease, year after year, we see the burden of heart failure continue to rise,” said senior author Muthiah Vaduganathan, MD, MPH, a cardiologist with the Mass General Brigham Heart and Vascular Institute. “Despite the many available treatments, we are not yet able to cure heart failure or consistently put people into remission. That’s why prevention, especially early prevention, is a priority.”

Heart failure affects more than 56 million people worldwide and the number of affected people continues to increase. In the three-part series published in The Lancet and presented at ESC, Vaduganathan and colleagues outline a roadmap to prevent heart failure before it begins.

The first paper in the series creates the foundation for understanding the lifetime burden of heart failure, which can affect more than 1-in-4 adults in some countries. The authors propose a framework for screening patients to assess their risk of disease and detect early signs.

The second paper focuses specifically on the prevention of heart failure after myocardial infarction (MI). More people survive heart attacks than ever before due to advances in emergency care and medical therapies. However, many develop heart failure in the months and years after. Authors propose a treatment pathway tailored to individual patient risk and discuss potential future strategies to incrementally lower the risk of development of heart failure after acute MI.

The third paper emphasizes that we know that heart failure isn’t solely a result of large heart attacks. In many countries, up to 80-90% of people with new-onset heart failure do not have a history of MI. Instead, heart failure is an under-recognized complication of other cardiovascular diseases (e.g., atrial fibrillation), chronic kidney disease, and metabolic diseases. These diseases also increasingly co-exist and amplify each other’s effects, and better prevention and management of these conditions could help reduce the risk of heart failure.

The authors note that there isn’t one road map that every healthcare setting should follow, but the series provides high-level concepts that can be transferable and adaptable to different systems worldwide, regardless of the country, income level, etc.

“We should be empowering people today to undergo timely screening with their healthcare providers,” said lead author John W. Ostrominski, MD, a fellow in cardiovascular disease and obesity medicine with the Mass General Brigham Heart and Vascular Institute. “Empowering patients to detect and treat risk factors before heart failure develops is key.”

Authorship: Additional authors include Sadiya S. Khan, Otavio Berwanger, Mona Fiuzat, John J.V. McMurray, Jagat Narula, Dorairaj Prabhakaran, Karen Sliwa, Jasper Tromp, Jacob A. Udell, M. Cecilia Bahit, Patricia Campbell, Javed Butler, Vijay K. Chopra, Antoni Bayés Genís, Biykem Bozkurt, Mark C. Petrie, Alice Y.Y. Cheng, Adam J. Nelson, Brendon L. Neuen, Naveed Sattar, and Katherine R. Tuttle.

Disclosures: JWO reports research support from the NIH and travel support from AstraZeneca and Bayer AG. MV has received consulting fees, research grants, or participated on clinical trial committees supported by several pharmaceutical companies including AstraZeneca, Boehringer Ingelheim, Bayer AG, Novartis, and Novo Nordisk. Complete disclosure information is included in each publication.

Papers cited:

1. Khan, S. et al. “Prioritizing the Primary Prevention of Heart Failure” The Lancet DOI: https://doi.org/10.1016/ S0140-6736(25)01393-5
2. Udell, J. et al. “Prevention of Heart Failure after Myocardial Infarction” The Lancet DOI: https://doi.org/10.1016/S0140-6736(25)01394-7
3. Ostrominksi, J. et al. “Cardiovascular, Kidney, and Metabolic Health: An Actionable Vision for Heart Failure Prevention” The Lancet DOI: https://doi.org/10.1016/S0140-6736(25)01384-4