Adrian Brown, PhD, NIHR Advanced Fellow and Associate Professor in Nutrition and Dietetics at University College London and programme co-lead of the MSc Dietetics (Pre-registration) course

Destigmatizing Obesity in Kidney Failure Patients Seeking Transplants, With Adrian Brown, PhD

barriers to equitable access in transplant care

 may open the door to a new future of clinical obesity management in this patient population.

This was the first systematic review to synthesize the perspectives of both clinicians and patients on obesity management in kidney failure before transplantation, and the findings underscored a disconnect between clinicians’ communication and patients' psychological well-being, especially when stigma was present.

“Enhancing communication is actually essential,” said Adrian Brown, PhD, NIHR Advanced Fellow and Associate Professor in Nutrition and Dietetics at University College London and programme co-lead of the MSc Dietetics (Pre-registration) course, in an interview with 

Clinicians should receive training to help them discuss weight sensitively, to guide weight bias and stigma, and to support patients in a way that makes them feel respected, and that the communication and the engagement are collaborative.”

Brown and colleagues conducted a mixed-methods systematic review, constructing 4 main themes from 738 participants from 7 studies investigating patients' and clinicians' perspectives on obesity management in kidney failure. These included:

Hungry and exhausted: The impact of dialysis on eating behaviour and activity (n = 339)

Weight stigma–lack of support, trust and open communication (n = 212)

Lack of resources as a barrier for weight loss (n = 339)

Who gets a transplant? Moving beyond BMI to improve equity in transplantation (n = 631).

In total, 4 studies included clinicians’ perspectives (n = 495), such as dieticians (n = 41), nephrologists (n = 438) and transplant surgeons (n = 12).

Hungry and exhausted: The impact of dialysis on eating behaviour and activity

Appearing in 6 papers, investigators identified diet and exercise as the most common weight loss interventions in patients with kidney failure.

From this study, investigators observed communication linguistics surrounding dietary advice included portion control, mindful eating and self-monitoring as the most common interventions for obesity management.

From a patient’s perspective, this guidance was hard to adhere to, given the “incompatibility” between this advice and the dietary/liquid restrictions, hunger, and exhaustion while going through dialysis. In fact, dialysis itself was often reported as a hindrance to weight loss based on its impact on eating behaviour, energy, and hunger, deterring intentional meal preparation and the stress and boredom patients expressed during treatment.

Building off of dialysis’s impact on energy related to diet, exhaustion was an obstacle for patients attempting to exercise, even though this was the second most common obesity management approach.

Weight stigma–lack of support, trust and open communication

This theme stood out as a measure of the communication barriers between patients and clinicians, specifically how instances of bias led to what patients described as inadequate support and advice, often leading them to feel responsibility and self-blame.

As study investigators observed, clinicians tended to tiptoe around conversations surrounding weight and obesity, not wishing to “embarrass” patients by initiating the topic. Dialysis facilities themselves were seen as a separate barrier, given the lack of privacy and public nature of treatment. Overall, clinicians either expressed an expectation for patients to bring obesity up for themselves, or a desire to focus on other clinical workload.

Investigators noted a few instances of clinicians' apparent bias and negative attitudes towards patients with obesity, and identified this stigma as a roadblock toward transplantation and a detriment to patients' psychological well-being.

Lack of resources as a barrier for weight loss

Brown and colleagues described this theme as resource-related barriers, including lack of time, limited obesity knowledge, and funding. Overall, these reduced the ability and motivation of the patient and clinician to address obesity.

Some patients viewed weight loss as time-consuming; others did not have an urgency to lose weight until reaching a more severe level of CKD. Notably, both patients and clinicians reported a lack of time and motivation to actively pursue or support weight loss.

According to Brown, many clinicians felt obesity management was outside the scope of their role, which led to gaps in care. Clinicians were unsure about their roles in addressing obesity in dialysis and identified the absence of obesity management guidelines as a key challenge.

Of note, barriers to food access, including cost and inaccessibility, were also identified as a major barrier to weight loss for patients with kidney failure.

Who gets a transplant? Moving beyond BMI to improve equity in transplantation

Lastly, from the findings, Brown and colleagues discovered 4 papers where clinicians considered obesity during transplant eligibility assessments. Overall, there was a lack of consensus on how to measure body composition or operationalize eligibility for kidney transplantation.

A majority of clinicians believed having a body mass index (BMI) ≥ 40 kg/m2 was a contraindication for kidney transplantation, with 50% suggesting a BMI of 40 kg/m2 was an appropriate limit, while others said 30–35 kg/m2. Otherwise, clinicians believed BMI limits excluded patients.

“There needs to be a shift to create a system that recognizes obesity as a medical condition in its own life, requiring coordinated care,” said Brown. “And this needs to be prioritized for transplant access, both for the patients and the clinicians, working towards getting better clinical outcomes and ultimately getting patients access to transplantation.”

Editor’s Note: Brown reports relevant disclosures with Novo Nordisk and Reset Health.

Oganesova Z, MacLaughlin HL, McCafferty K, et al. Patient and clinician perspectives on the management of obesity in kidney failure prior to kidney transplantation: a mixed-methods systematic review. eClinicalMedicine. 2026;91:103649. doi:

https://doi.org/10.1016/j.eclinm.2025.103649

Brown A. Barriers to Obesity Management in Kidney Failure Before Transplantation. HCPLive. Published February 24, 2026. Accessed February 26, 2026. 

https://www.hcplive.com/view/barriers-to-obesity-management-in-kidney-failure-before-transplantation

Videos

Brown discusses a destigmatised future of obesity management in patients with kidney failure. 


Clinical

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The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

Chronic Kidney Disease

RSV Vaccine Demonstrates Cardioprotective Effects, Reduces MACE and Hospitalizations, With Deepak Bhatt, MD, MPH

A study conducted by GSK, investigating its Respiratory Syncytial Virus (RSV) Vaccine, Adjuvanted (Arexvy), has highlighted the vaccine’s efficacy in reducing 

major adverse cardiovascular events (MACEs)

 and RSV-related hospitalizations in adults ≥60 years.

Arexvy is comprised of recombinant RSV glycoprotein F stabilized in the prefusion conformation, combined with GSK’s proprietary adjuvant AS01E. The vaccine has already received approval for the prevention of lower respiratory tract disease due to RSV in the same patient population, as well as for those aged 50-59 years who are at greater risk of the disease.

“First of all, preventing a bad infection can secondarily prevent bad side effects of the infection, and we this all the time even outside of RSV when patients come in and they’re vulnerable, or they’re over the age of 60, and they may have underlying cardiac disease,” Deepak Bhatt, MD, MPH, director of the Mount Sinai Fuster Heart Hospital and the Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai, told 

 in an exclusive interview. “The other possibility is a little more speculative; perhaps the infection itself is triggering inflammation that is triggering the heart attack.”

Presented at RSVVW’26, the 9th Conference of the Respiratory Syncytial Virus Foundation in Rome, this retrospective cohort study aimed to estimate the vaccine effectiveness of Arexvy against MACE and severe exacerbations of 

chronic obstructive pulmonary disease (COPD)

. The team collected claims data from the Optum Research Database, including patients aged ≥60 years identified between August 2023 and May 2024. For vaccinated patients, the index date was the date of vaccination.

Investigators then matched each vaccinated patient to 4 unvaccinated patients on age, sex, insurance type, and state of residence. Baseline characteristics were measured during the 12 months pre-index, while the follow-up period began 14 days post-index. Each outcome, including MACE and flare-ups of COPD or asthma, was measured overall and regarding RSV-related outcomes.

Ultimately, the trial enrolled a total of 520,440 vaccinated patients, who were then exact matched in a 1:4 to 2,081,760 unvaccinated patients. Mean age across all patients was 74.3 years (standard deviation [SD], 6.7). 869,980 patients had existing cardiovascular disease, 362,615 had existing COPD, and 244,226 had existing asthma.

Among adults with existing cardiovascular disease, the vaccine’s effectiveness against MACE was 20.4% (95% CI, 18-22.9%). Effectiveness against RSV-related MACE was 63.1% (41.8-76.6%), while effectiveness against severe COPD and asthma exacerbations overall was 8.6% (4.2-12.7%) and 19.4% (5.7-31.1%), respectively. For RSV-related severe COPD and asthma exacerbations, effectiveness estimates were 74.4% (59.3-83.9%) and 61.6% (9.1-83.7%), respectively.

Ultimately, investigators determined that these data highlight a substantial benefit of adjuvanted RSVPreF3 vaccination in preventing RSV-related MACE, as well as severe asthma and COPD exacerbations among patients ≥60 years.

“I think this is going to be an area of future investigation for other vaccines as well,” Bhatt said. “For instance, vaccinating for shingles, beyond just reducing the risk of developing recurrent shingles, can potentially have cardiovascular benefits. This is something that would need to be studied in randomized clinical trials, of course, but certainly there are emerging observational data supporting that.”

Editor’s Note: Bhatt reports disclosures with GSK, Merck, Cereno Scientific, Angiowave, Boehringer Ingelheim, Novo Nordisk, and others.

GSK. GSK’s Arexvy associated with reductions in certain RSV-related risks including heart attack, stroke, and severe flare-ups of COPD and asthma, real-world study shows. February 17, 2025. Accessed February 26, 2026 

https://www.gsk.com/en-gb/media/press-releases/gsk-s-arexvy-associated-with-reductions-in-certain-rsv-related-risks-including-heart-attack-stroke-and-severe-flare-ups-of-copd-and-asthma-real-world-study-shows/

Livingston R. Arexvy Vaccine Reduces Hospitalization, Major Adverse Cardiovascular Events in RSV. 

. February 18, 2026. Accessed February 26, 2026. 

https://www.hcplive.com/view/arexvy-vaccine-reduces-hospitalization-major-adverse-cardiovascular-events-in-rsv

Singer D, Steffens A, La E, et al. Effectiveness of adjuvanted RSVPreF3 vaccine in preventing major adverse cardiovascular events, severe asthma exacerbations, and severe COPD exacerbations among US adults aged 60 years and older. Poster presented at the ReSViNET 2026; February 17, 2026. Accessed February 26, 2026. 

https://www.rtihs.org/publications/effectiveness-adjuvanted-rsvpref3-vaccine-preventing-major-adverse-cardiovascular

Bhatt discusses a recent study from GSK highlighting AREXVY’s efficacy in lowering major adverse cardiovascular events.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

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Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

Abigail Brooks is an assistant managing editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

Complex vascular disease is becoming more prevalent and more complicated. Patients are living longer with diabetes, hypertension, and chronic kidney disease, conditions that accelerate aortic degeneration and peripheral arterial disease. At the same time, advances in imaging, device technology, and minimally invasive techniques have expanded what is technically possible.

The result is a field that demands increasingly nuanced decision-making, particularly for patients with complex aortic aneurysms or chronic limb-threatening ischemia (CLTI), with success in this environment depending on individualized strategy, multidisciplinary coordination, and thoughtful integration of emerging technologies.

Ross Milner, MD, Louis Block Professor of Surgery and chief of the section of Vascular Surgery and Endovascular Therapy at University of Chicago Medicine, explains that the vascular program at UChicago Medicine is built to manage the most challenging aortic cases—patients who are often referred after being deemed too high-risk or too anatomically complex for standard repair.

“Any aortic repair that involves branches of the aorta, to us, is a complex repair,” Milner explained. “So whether it's in the aortic arch, in the chest, in the abdomen, anything that becomes a little bit more than just a repair below the arteries to the kidneys, gets to be complex and requires a team approach.I think that's something that we do very well here with the different specialties that are involved with taking care of those patients.”

Determining whether to pursue open surgery, endovascular intervention, or a hybrid approach requires careful analysis of anatomy, comorbidities, and long-term durability, he says. While endovascular techniques continue to evolve, Milner emphasizes that open repair remains essential in select patients, particularly younger individuals or those with anatomy less suited to stent-based solutions.

Advanced imaging plays a central role in that decision-making process. Milner notes that high-resolution CT reconstruction and three-dimensional planning allow surgeons to map branch vessels, landing zones, and access challenges with increasing precision. He also highlights the growing role of artificial intelligence in postoperative surveillance. AI-driven platforms can help monitor imaging over time, detect subtle changes, and standardize follow-up—tools he believes will improve long-term outcomes and reduce missed complications.

Among these advancements, the recent displays of the Heartflow PCI Navigator have roused substantial excitement. The device, still very much in its pre-clinical investigative phase, will examine CT scan data and leverage AI to generate 3D maps of the patient’s vascular system, allowing clinicians to properly plan optimal stent placement before entering the catheterization lab.

Beyond the aorta, Milner points to chronic limb-threatening ischemia as an area requiring earlier recognition and intervention. Many patients present late in the disease course, when tissue loss and infection increase the risk of amputation. He stresses that limb preservation depends on coordinated care among vascular surgeons, podiatrists, wound specialists, and interventionalists. Early referral, aggressive revascularization when appropriate, and structured follow-up are critical components of preventing limb loss.

Milner also underscores the importance of tailoring therapy rather than defaulting to a single technique. Some patients benefit most from minimally invasive revascularization, while others require open bypass for durable blood flow restoration. The key, he says, is maintaining the full spectrum of expertise so that treatment decisions are driven by patient-specific factors rather than procedural preference.

“The good part for a place like ours is we have many specialists that can take care of peripheral vascular disease and chronic limb threatening ischemia, so we can offer the full spectrum. We do open surgery, we do endovascular approaches, we do hybrid approaches, we do them all, and the decision gets made as we look at the patient's anatomy and look at their overall risk and say, what do we think is best for this given patient?” Milner explained. “I think what's important is to be at a place where all these options are available and we can make the best decision for a patient based on what they need, and not just what an individual provider can do.”

Looking ahead, Milner believes the field will continue to shift toward greater integration of digital planning tools, cloud-based imaging review, and predictive analytics. But even as technology advances, he maintains that outcomes ultimately depend on experience, collaboration, and disciplined clinical judgment.

As vascular disease grows more complex, Milner argues that comprehensive programs—capable of combining innovation with surgical depth—will be best positioned to deliver durable results for high-risk patients.

Heartflow. New Heartflow PCI Navigator to Equip Interventional Cardiologists with Pre-procedural Insights to Enable PCI Planning. October 22, 2025. Accessed February 12, 2026. 

https://ir.heartflow.com/news-releases/news-release-details/new-heartflow-pci-navigator-equip-interventional-cardiologists

Articles

Complex vascular disease is increasing as patients live longer with diabetes, hypertension, and chronic kidney disease, driving more aortic degeneration and peripheral arterial disease. Management of complex aortic aneurysms and CLTI increasingly requires individualized strategy, multidisciplinary coordination, and appropriate use of evolving technologies. Complex aortic repairs involving branch vessels demand careful selection among open, endovascular, and hybrid approaches, supported by high-resolution CT reconstruction and 3D planning. AI-enabled surveillance and emerging AI-based CT planning tools may improve follow-up and procedural planning, but outcomes remain grounded in expertise and collaboration.

Ross Milner, MD, discusses rising vascular complexity, advanced imaging and AI, and the team-based strategies driving durable aortic and limb salvage outcomes.

Atherosclerotic Cardiovascular Disease

Expanding the Toolbox for Complex Aorta and Limb Salvage

Joselle Cook, MD, MBBS, is a hematologist and oncologist, specializing in Myeloma, Amyloid and Plasma cell disorders at the Mayo Clinic in Rochester Minnesota.

 published new clinical practice guidelines aimed at improving the early, timely, and accurate diagnosis of 

, a disease frequently missed or diagnosed late due to its heterogeneous presentation

The recommendations emphasize blood and urine testing, including serum immunofixation, urine immunofixation, and serum free light chain assays, whenever clinical suspicion for AL amyloidosis arises. To confirm diagnosis, the panel supports surrogate tissue sampling through combined bone marrow biopsy and fat pad aspirate in most cases, while noting that target organ biopsies may be warranted in select scenarios.

HCPLive spoke with panel member Joselle Cook, MD, MBBS, a hematologist and oncologist, specializing in Myeloma, Amyloid and Plasma cell disorders at the Mayo Clinic in Rochester Minnesota for insight into the rationale behind the guidelines.

HCPLive: What gap in current clinical practice did ASH most urgently aim to address with these new diagnostic guidelines for AL amyloidosis?

This gap for AL amyloidosis really is the delay and inconsistency in the diagnosis of light chain amyloidosis, and that is what really results in the significant morbidity and mortality, especially if diagnosed late across multiple specialties. There really hasn't been any shared evidence pathway for when to order prior protein testing, which biopsies to do first, and how to distinguish from, etc, cardiac amyloid. So these guidelines are really unique because they give a common roadmap for patient workup to lead to the most efficient diagnosis, whether they start with a cardiologist, nephrologist, neurologist, or with a hematologist.

HCPLive: Which of the 12 recommendations represents the most meaningful shift from current diagnostic practice?

The important shift to me is the emphasis of combined serum and urine immunofixation, plus serum free light chains obtained all together and up front and clearly defined red flag scenarios such as cardiac amyloidosis or unexplained proteinuria. Too often we have seen missed or delayed diagnoses of AL amyloid if only the serum protein electrophoresis was obtained without the free light chains or immunofixation because the amyloid clone is so small. This triad of tests really is essential to support earlier suspicion and diagnosis of the monoclonal protein and, therefore, appropriate referral to hematology. So for me, those are the most meaningful shifts with these guidelines. This pathway is more efficient because it replaces fragmented, sequential workup with a standardized strategy.

The guidelines outline a stepwise approach that starts with combined blood and urine testing and moves to surrogate biopsies using bone marrow and fat pad sampling. How does this diagnostic pathway work mechanistically to both raise clinical suspicion earlier and confirm AL amyloidosis more efficiently than prior approaches?

In the past, patients often underwent multiple isolated evaluations, so a cardiologist would order imaging, and the patient would visit a neurologist who would focus on the neuropathy and so forth, and the monoclonal protein testing was sometimes delayed or incomplete, which led to repeated visits, organ biopsies, and months of diagnostic drift. So this new approach really does three things differently. Number one, it standardizes early testing when red flags appear. Clinicians order this triad of serum immunofixation, urine immunofixation, and free light chains together, and that would really immediately identify or exclude a clonal process. Then, number two, the guidelines move quickly to recommend surrogate tissue confirmation, which diagnoses the majority of light chain amyloid cases; the bone marrow and fat aspirate together has a sensitivity of about 89%, which is really excellent. And then third, it aligns specialties all around the same pathway. So this would reduce redundant imaging and prevent delays caused by uncertainty about next steps.

HCPLive: For patients with suspected cardiac involvement, how do the guidelines help clinicians decide between surrogate biopsies and endomyocardial biopsy in real-world settings?

Patients with suspected cardiac amyloidosis or light chain cardiac amyloidosis, who have positive monoclonal testing, abnormal cardiac biomarkers, and an echocardiogram consistent with amyloid. The key issue here is not whether to biopsy, it's which biopsy to start with. And so the guidelines support two reasonable pathways. One is to begin with the surrogate sites, meaning the fat pad sampling and the bone marrow biopsy, which is less invasive, as I said, really great sensitivity of about 89%, and often confirm systemic AL with proper subtyping, which may altogether eliminate the need for heart biopsy. But the other option is to proceed directly to an endomyocardial biopsy, and this actually may be preferred in certain instances where rapid diagnostic certainty is needed, or where there's a strong local expertise in doing endomyocardial biopsies, or if there's concern for ATTR amyloid, including other hereditary forms. And so the central message here really is simple: imaging can raise suspicion, but you really need tissue to establish the diagnosis and the subtype of amyloid, and the biopsy strategy should be individualized to the patient and to the clinical scenario

HCPLive: Because patients often present outside hematology, which specialties need to be most aware of these guidelines, and why?

The clinical guidelines were intentionally multidisciplinary, since all specialties are likely to encounter patients at various stages along their symptom journey. So general internists, cardiologists, nephrologists, neurologists, gastroenterologists, they all need to have a clear, evidence-based framework to recognize amyloidosis and how to initiate an appropriate workup. And I would also add that the companion scoping review on symptoms and red flags across the different amyloid subtypes is equally important, and I would encourage everyone to read that as well. It gives clinicians the practical clinical clues that should trigger testing, and together, the two papers aim to shorten diagnostic delay by aligning suspicion and diagnostic strategy across specialties.

HCPLive: If clinicians take away just one action item from these new ASH guidelines, what should it be?

For adults with otherwise unexplained red flag features for systemic amyloidosis, please order serum immunofixation, urine immunofixation, and serum free light chains together, and if they're abnormal, involve a center with amyloidosis expertise for bone marrow and fat pad biopsy. If that habit spreads across cardiology, nephrology, neurology, and internal medicine, we will shorten the time to diagnosis, avoid inappropriate testing, and give more patients a chance at organ-saving treatment."

Editor’s Note: Cook reports no relevant disclosures. 

ASH publishes clinical practice guidelines on diagnosis of light chain amyloidosis. EurekAlert! Published January 28, 2026. Accessed January 28, 2026. 

https://www.eurekalert.org/news-releases/1114078

Hillenbrand A. ASH Releases New Clinical Practice Guidelines for Diagnosing AL Amyloidosis. HCPLive. Published January 28, 2026. Accessed February 25, 2026. 

https://www.hcplive.com/view/ash-releases-new-clinical-practice-guidelines-for-diagnosing-al-amyloidosis

ASH clinical practice guidelines target delayed and inconsistent recognition of AL amyloidosis by standardizing an upfront diagnostic pathway across specialties. Core recommendations prioritize simultaneous serum immunofixation, urine immunofixation, and serum free light chain testing when red flags arise (eg, cardiac phenotype, unexplained proteinuria), reducing missed small plasma cell clones. Confirmation generally proceeds via surrogate tissue sampling with combined bone marrow biopsy plus abdominal fat pad aspirate, offering ~89% sensitivity and often obviating organ biopsy. For suspected cardiac involvement, biopsy strategy is individualized, balancing invasiveness, urgency, and ATTR concern.

Panelist member explains new ASH guidelines aim to improve early diagnosis of AL amyloidosis with blood, urine, and biopsy testing.


Hematology

Key Insights on New ASH Guidelines for AL Amyloidosis, With Joselle Cook, MD

 care has entered a new era defined by rapid therapeutic expansion and increasing clinical complexity. Patients are living longer, new pharmacologic and device-based therapies are reshaping prognosis, and once-fatal diagnoses are now managed with durable strategies.

However, with new medications comes an increased medication burden for patients. Quadruple therapy - including SGLT2 inhibitors, beta-blockers, MRAs, and ARNIs - has become a cornerstone of postoperative therapy, with the goal of reducing morbidity and mortality after hospital discharge. The sheer number of pills required for this therapy, as well as the need for increased clinician oversight, substantially increases the time and resources invested in care.

Notably, this progress has also introduced difficult decision-making, heavier medication burdens, and the need for highly coordinated subspecialty care. According to Manreet Kanwar, MD, a professor of medicine at the University of Chicago Medicine and director of the Heart Failure and Pulmonary Hypertension program, delivering optimal outcomes today requires more than access to advanced treatments. It demands an integrated system built specifically to manage the sickest patients.

Kanwar explains that the heart failure program at UChicago Medicine has evolved to meet that challenge, featuring a team of 12 dedicated heart failure physicians who treat patients across the full spectrum of disease, from early-stage heart failure to those requiring mechanical circulatory support or heart transplantation. She emphasizes that a major differentiator of the program is its concentration of advanced heart failure expertise, particularly for patients who have failed standard medical therapy and present in critical condition.

Many of these individuals require evaluation for left ventricular assist devices (LVADs), temporary mechanical support, or transplant. She notes that careful patient selection, multidisciplinary review, and timely escalation of care are essential for achieving favorable outcomes.

Kanwar also points to pulmonary hypertension as a growing focus. Under cardiology leadership, the relaunched program provides comprehensive inpatient and outpatient management.

“This is a very unique patient population, in some ways similar to heart failure, and in some ways not necessarily, because these patients almost always have problems or issues with the right side of the heart, unlike the traditional heart failure, where they have issues with the left side of the heart,” she said. “We see these patients in our clinic, we start them on medical therapy, we work closely with our pulmonary as well as lung transplantation colleagues, because many of these patients require those kinds of therapies.”

One of the most transformative areas, according to Kanwar, has been cardiac amyloidosis. Once associated with limited treatment options and poor survival, the condition now represents a rapidly advancing field. She describes how structured diagnostic pathways, subtype-specific management, and access to multiple clinical trials, particularly those targeting transthyretin, have changed the outlook for patients. The program now follows hundreds of individuals with cardiac amyloid, reflecting both increased awareness and improved detection.

Pharmacologic innovation has similarly reshaped the broader heart failure landscape. Kanwar explains that contemporary guideline-directed medical therapies reduce hospitalizations and prolong survival across multiple heart failure subtypes. However, she acknowledges that these benefits often come with increased pill burden, especially in patients with diabetes, kidney disease, and hypertension. Balancing medication complexity with measurable outcome gains is an ongoing challenge requiring individualized assessment and shared decision-making.

Beyond clinical interventions, Kanwar underscores the importance of psychosocial support. Recurrent hospitalizations and progressive symptoms can take a profound emotional toll. Integrated social work and behavioral health resources, she notes, are essential components of comprehensive heart failure care.

“[Heart failure] is a disease that often does not come in isolation. These patients have, for example, diabetes, high blood pressure, they're more likely to have other issues like kidney failure, sometimes stroke and anemia,” she explained. “These patients then end up back in the hospital often, and this interplays into the significant burden of depression… We try to support them, of course, through medical options, but also ably supported by our colleagues, including in social work and psychology, and also sometimes we refer them to psychiatry. We may not be best trained to suit those needs, but we recognize them and try to connect the dots for these patients.”

Additionally, psychosocial support has the capacity to increase adherence to practical preventive factors, such as the well-known Life’s Essential 8. According to data from the American Heart Association (AHA), factors such as smoking, obesity, physical activity, nutrition, and sleep contribute so strongly to cardiovascular disease prevention that adherence to the LE8 suggestions could prevent up to 40% of cardiovascular deaths annually.

As therapies grow more sophisticated, Kanwar believes the future of advanced heart failure depends on systems designed to manage complexity, clinically, technologically, and emotionally, while keeping patients at the center of every decision.

Editors’ Note: Kanwar reports relevant disclosures with Abiomed and Abbott.

Greene SJ, Xu H, Chiswell K, et al. One-year outcomes in patients hospitalized for heart failure with reduced ejection fraction prescribed quadruple medical therapy at discharge. JAMA Cardiology. Published online January 28, 2026. doi:10.1001/jamacardio.2025.5339

Palaniappan LP, Allen NB, Almarzooq ZI, et al. 2026 heart disease and stroke statistics: A report of US and Global Data from the American Heart Association. Circulation. Published online January 21, 2026. doi:10.1161/cir.0000000000001412

Advanced heart failure management is increasingly shaped by rapid therapeutic innovation alongside escalating clinical complexity. Guideline-directed quadruple therapy improves postdischarge outcomes but adds substantial pill burden and requires intensified monitoring. Optimal results increasingly depend on specialized, integrated programs capable of timely escalation to temporary support, LVAD, or transplantation. Pulmonary hypertension and cardiac amyloidosis are expanding priorities, supported by structured diagnostics and trial access, especially for transthyretin targets. Psychosocial comorbidity, depression, and adherence barriers necessitate embedded social work and behavioral health, reinforcing patient-centered shared decision-making.

Manreet Kanwar, MD, outlines advances in heart failure care, rising medication complexity, and the need for integrated, patient-centered systems.

Heart Failure

The HCPLive heart failure page is a resource for medical news and expert insights on HF. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for heart disease, reduced and preserved ejection fraction, and more.

Comprehensive, Multidisciplinary Care for Complex Cardiac Disease

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

AAAAI 2026 showcases high-impact clinical trials and innovative sessions, 5 of which are highlighted below.



Conference

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Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

AAAAI Annual Meeting 2026 Preview: 5 Trials to Know

David Rubin, MD, discusses rapid advances in IBD care, new therapies, multidisciplinary models, and the push toward precision GI medicine.

Gastroenterology

Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

Hepatology

Inflammatory Bowel Disease

On the HCPLive inflammatory bowel disease page, resources on the topics of medical news and expert insight into IBD can be found. Content includes articles, interviews, videos, podcasts, and breaking news on IBD and more.

Expanding Clinical Reach in GI and Hepatology While Preserving Standards of Care

Gregg Pressman, MD, is a professor of medicine in the division of cardiology, Jefferson Einstein Philadelphia Hospital, Thomas Jefferson University.

Pressman discusses his recent study highlighting the interplay between right ventricular end-diastolic volume and ejection fraction and the left ventricle’s health.

Structural Heart Disease

Strategic Alliance Partnership

Low-Grade Diastolic Dysfunction Still Harms Left Ventricle Function, With Gregg Pressman, MD

Fernando Magro, MD, PhD, is head of clinical pharmacology at University Hospital São João.

4-year LUCENT data show mirikizumab reduces UC-related hospitalizations and surgeries, supporting durable remission and potential disease modification.

Ulcerative Colitis

Ulcerative Colitis condition center page, resources on the topics of medical news and expert insight into colitis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on UC research, treatment, and drug development.

LUCENT: Durable UC Control With Mirikizumab Through 4 Years, With Fernando Magro, MD, PhD

In this interview, Neal Bhatia, MD, highlights several key points about treating psoriasis and obesity via ixekizumab and tirzepatide.

Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Discussing Promising New Findings on GLP-1 Use in Psoriasis Management, With Neal Bhatia, MD

Ryan Livingston joined the MJH Life Sciences team in March of 2025, shortly after graduating from TCNJ with a bachelor’s degree in English. He enjoys creative writing, reading, and scuba diving. He can be reached at rlivingston@mjhlifesciences.com.

Parent company Eli Lilly has released full data from ACHIEVE-3, indicating superior weight loss and A1C reductions with orforglipron 12 mg and 36 mg.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Type 2 Diabetes

ACHIEVE-3: Orforglipron Achieves Superiority to Oral Semaglutide in Poorly Controlled T2D

The supplemental New Drug Application submission comes as a result of positive phase 3 data from the CORE and CORE2 trials or olezarsen in 2025.

Dyslipidemia

FDA News

FDA Accepts Olezarsen’s sNDA for Severe Hypertriglyceridemia, Grants Priority Review

Muthiah Vaduganathan, MD, MPH, is a cardiologist specializing in cardiorenal metabolism at Brigham and Women's Hospital in Boston, MA. Vaduganathan is a member of Practical Cardiology's advisory board and co-host of Don't Miss a Beat, a podcast presented by Inside Cardiology.

Why CKD screening lags despite aligned KDIGO, ADA and hypertension guidance—use eGFR plus UACR staging and EHR prompts to act earlier.

Video Series

Understanding the Link Between Early CKD Diagnosis and Cardiovascular Outcomes

CKD guidelines agree: use eGFR plus UACR for KDIGO staging, but screening lags—see how teams and EHRs close the gap.

Quality of Life Impact of Delayed CKD 

Timothy E. Dribin, from the division of emergency medicine, at Cincinnati Children’s Hospital Medical Center.

Expert panel identifies high agreement for multi-organ involvement, but uncertainty remains in moderate isolated skin or mucosal symptoms.

Anaphylaxis

The HCPLive anaphylaxis page is a comprehensive resource for clinical news and insights on acute allergic reactions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for preventing anaphylaxis, and more.

Latest News

Destigmatizing Obesity in Kidney Failure Patients Seeking Transplants, With Adrian Brown, PhD

RSV Vaccine Demonstrates Cardioprotective Effects, Reduces MACE and Hospitalizations, With Deepak Bhatt, MD, MPH

Expanding the Toolbox for Complex Aorta and Limb Salvage

Key Insights on New ASH Guidelines for AL Amyloidosis, With Joselle Cook, MD

Comprehensive, Multidisciplinary Care for Complex Cardiac Disease