Anuradha Lala-Trindade, MD

Improving Patient Education and Pill Burden in Heart Failure Treatment, With Anuradha Lala, MD

Although the overall nature of addressing 

 in clinics has shifted to a more holistic approach, improvements can still be made to the patient’s side of treatment, including pill burden and patient education.

“Unfortunately, there’s a major gap between evidence and widespread, broad understanding,” Anuradha Lala, MD, professor of medicine, cardiology, and population health, director of the ACGME Fellowship in Advanced Heart Failure and Transplant, and Director of the Heart Failure Clinical Trials program at Mount Sinai Hospital, told 

 in an exclusive interview. “Despite patient behavior having an influence on outcomes, there are studies after studies that show that patients often leave a heart failure hospitalization without a clear understanding of what the disease is, why their medications matter, and what warning signs should prompt them to call us.”

HF is a product of several lifestyle factors including sleep, diet, exercise, and lipid levels. However, data from a past meta-analysis have shown that roughly 60% of premature deaths from HF could be attributed to unhealthy lifestyle factors. Additionally, roughly half of patients with HF do not follow recommended treatment procedures, limiting their chances of improvement.

Prior research has emphasized the importance of informing patients of the potential risks of HF and how to manage them in their everyday life. A study from 2021, during which a proportion of patients were given 4-step education sessions to address misconceptions and potential lifestyle improvements, indicated increased capacity for self-management of risk factors afterwards. Patients who received education on their condition were more open to clinician suggestions for management.

Another well-documented issue facing patients and clinicians alike is the pill burden present in HF treatment. The main medication cascade currently consists of 4 main drugs, known as the pillars of heart failure: angiotensin receptor-neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors. Standard GDMT recommends using all 4 treatments in every patient – given the sheer number of pills this requires, coupled with the disease’s implicit effects on quality of life, patients face a substantial burden simply from managing HF.

“The average patient with heart failure with reduced ejection fraction is taking somewhere between 6 and 10 meds when you account for all their comorbid conditions or other risk factors like 

, depression, et cetera,” Lala said. “And then the 4 pillar GDMT on top of that is not trivial.”

Despite these limitations, the ongoing shift towards a more multidisciplinary means of treatment – including nephrology and endocrinology, among other specialties – is an encouraging step towards better HF care. Chief among this movement is the cardio-kidney-metabolic framework put forth by the American Heart Association in 2023, highlighting the interplay between cardiovascular health and major comorbidities like 

“I think that adopting this cardio-kidney-metabolic framework really emphasizes the various aspects of the disease,” Lala said. “It’s about underlying inflammation, altered physiology and hormone health, coupled with poor diet, lack of exercise, and so on, that leads ultimately to the manifestations of heart disease, heart failure being one of its most prominent forms. I think us shifting to understand that we need to treat patients holistically and not in our silos of expertise is huge, and I pray that patients will stand to do better from our more holistic standards of care.”

Editors’ Note: Lala reports disclosures with Abiomed, AstraZeneca, Merck & Co., Novo Nordisk, Sequana, Bayer, and others.

1: Podvorica E, Bekteshi T, Oruqi M, Kalo I. Education of the Patients Living with Heart Disease. Mater Sociomed. 2021;33(1):10-15. 

2: Smith JL, Killian JM, Shippee N, et al. Burden of treatment in patients with heart failure. Journal of the American Heart Association. 

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Lala discusses ongoing challenges in the HF treatment cascade, highlighting widespread misunderstandings among patients and the issue of extreme pill burden.

ISHLT Provides Updates in Xenografting in Patients with Cardiac Diseases, With Anu Lala, MD

On February 20, 2026, the International Society for Heart and Lung Transplantation (ISHLT) released a consensus statement aiming to redefine the challenges and outline recommendations for moving forward in the field of xenotransplantation for end-stage 

This consensus statement builds on an existing document published in 2000, which highlighted the urgent need for donor organs for use in patients with cardiac and pulmonary diseases. To counter this, the authors indicated a potentially unlimited supply of hearts and lungs via pig organs. Of course, the document also acknowledged the natural barriers of antibody-mediated mechanisms in both the pig heart and the human recipient, which resulted in rejection after transplantation into non-human primates in earlier trials.

The 2026 consensus statement builds upon recent research, including the successful performance of 2 clinical heart xenotransplant cases. However, many of the challenges highlighted in the 2000 statement still linger 26 years later. As a result, the ISHLT committee behind the current statement designed it as a “living blueprint,” leaving it open for further editing and sculpting as the procedure is duplicated and thornier issues, such as ethical concerns, are worked out over time.

“This was a real tour de force,” Anuradha Lala, MD, professor of medicine, cardiology, and population health, director of the ACGME Fellowship in Advanced Heart Failure and Transplant, and Director of the Heart Failure Clinical Trials program at Mount Sinai Hospital, told 

 in an exclusive interview. “This document matters now because the field needed a living blueprint. We’ve had 2 human pig heart transplants, so we know that xenografts can function, but we also know that they can fail. We’re trying to learn why, and it’s an evolving process.”

The 2 successful xenografts lasted 60 and 40 days, respectively. The first, a 57-year-old man with advanced 

, underwent a challenging, yet ultimately successful, operation. Weeks 2 through 5 exhibited a stable trajectory, after which point the patient became unstable, showing hypotension, abdominal distension, and low output syndrome with low mixed venous saturation.

The second graft was more challenging; the patient, a 58-year-old man, suffered cardiac arrest prior to transplantation and developed renal dysfunction. By day 13, endomyocardial biopsy revealed antibody-mediated rejection (AMR), and by day 31, the patient required mechanical circulatory support following graft failure. Care was withdrawn on day 40.

These operations, although ultimately resulting in graft failure, proved greatly informative for clinicians, providing further data regarding immunosuppression and monitoring following xenotransplantation. The consensus statement also makes note of emerging techniques and tools, including gene expression profiling and donor-derived cell-free DNA in blood, to survey immunological challenges. However, they also acknowledge that these are largely underexplored in xenotransplantation. These, among other advancing mechanisms, are recommended for further study.

“People are dying on the wait list every day, and the reason, of course, is because we’re constrained by donor hearts in a way that no surgical innovation, including LVAD optimization, has been able to overcome,” Lala said. “Xenotransplantation, which at some previous point might have seemed like science fiction, is a real clinical necessity that we’re working towards in a very thoughtful, disciplined, and now structured way.”

1: Mehra MR, Mohiuddin MM, Reichart B, et al. The 2026 International Society for Heart and Lung Transplantation Consensus Statement on clinical cardiac xenotransplantation. J Heart Lung Transplant. Published online January 30, 2026. 

2: Cooper DKC, Keogh AM, Brink J, et al. Report of the Xenotransplantation Advisory Committee of the International Society for Heart and Lung Transplantation: The Journal of Heart and Lung Transplantation. 2000;19(12):1125-1165. 

Lala discusses the ethical, medical, and practical concerns surrounding xenotransplantation of pig hearts – and how they should be addressed in clinical research.

Making Heart Failure Prevention Accessible

A joint statement by the American Society for Preventive Cardiology (ASPC) and the Heart Failure Society of America (HFSA), published on August 13, 2025, shifts the focus of 

 from recovery to prevention for the first time. “The Continuum of Prevention and Heart Failure in Cardiovascular Medicine” provides clinicians with a framework of strategies to apply across all stages of heart failure, irrespective of ejection fraction.

Instead of viewing the condition as an inevitable outcome, this statement recontextualizes heart failure as a preventable condition. It encourages clinicians to identify and manage risk factors earlier through methods such as glucose management, genetic risk screening, lifestyle interventions, weight loss, and blood pressure control.

In the seventh and final episode of a 7-part 

, moderator James Januzzi, MD, is joined by Martha Gulati, MD, MS, and Anu Lala, MD, to discuss the urgent need to bridge the gap between prevention and heart failure care.

Januzzi highlights ongoing inequities in cardiovascular care, noting that heart failure and related risk factors disproportionately affect marginalized populations with limited access to quality healthcare. He stresses that addressing these disparities will require significant health system and policy changes, especially as demographic shifts in the U.S. are projected to increase the burden of disease in these communities.

Lala adds 5 key takeaways for primary care: heart failure is preventable; prevention applies across the lifespan; screening should start early using tools like natriuretic peptides and UACR; patient care must take a whole-person, whole-team approach; and clinicians should proactively prescribe effective therapies such as SGLT2 inhibitors, ARNIs, and aggressive blood pressure control.

, is the Hutter Family Professor of Medicine at Harvard and the Director of Heart Failure and Biomarker Trials at the Balm Institute for Clinical Research. Januzzi serves as the moderator for this conversation.

, is the associate director of the Barbra Streisand Women Heart Center and the director of CVD Prevention at the Smidt Heart Institute at Cedars Sinai Medical Center. She was also the president of the ASPC from 2022-2024.

, is an associate professor of medicine at the Zena & Michael A Wiener Cardiovascular Institute, and a member of the Department of Population Health Science and Statistics at Icahn School of Mount Sinai and Mount Sinai Hospital.

Editors’ Note: Januzzi reports disclosures with Abbott Laboratories, AbbVie, Inc., Eli Lilly, AstraZeneca Pharmaceuticals, Jana Care, Siemens, and others. Gulati reports disclosures with the American Society of Preventive Cardiology, Eli Lilly, Merck & Co., Boehringer Ingelheim Pharmaceuticals, Medtronic, Zoll, and others. Lala reports disclosures with Abiomed, AstraZeneca, Merck & Co., Novo Nordisk, Sequana, Bayer, and others.

Heart Failure Society of America. Heart Failure Society of America and American Society for Preventive Cardiology Joint Statement Calls for a Shift in Heart Failure Prevention and Care. 

 August 13, 2025. Accessed September 9, 2025. 

https://www.prnewswire.com/news-releases/heart-failure-society-of-america-and-american-society-for-preventive-cardiology-joint-statement-calls-for-a-shift-in-heart-failure-prevention-and-care-302529062.html

Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in Cardiovascular Medicine: A joint scientific statement from the Heart Failure Society of America and the American Society for Preventive Cardiology. American Journal of Preventive Cardiology. Published online August 13, 2025:101069. 

In the final segment of this 7-part HCPLive Special Report, experts discuss the recently released ASPC/HFSA heart failure prevention statement.

HFSA/ASPC Heart Failure Prevention: Making Heart Failure Prevention Accessible

Heart Failure in Women

Instead of viewing the condition as an inevitable outcome, this statement recontextualizes heart failure as a preventable condition. It encourages clinicians to identify and manage risk factors earlier through methods such as glucose management, genetic risk screening, lifestyle interventions, weight loss, and blood pressure control.1

 moderator James Januzzi, MD, is joined by Martha Gulati, MD, MS, and Anu Lala, MD, to discuss the urgent need to bridge the gap between prevention and heart failure care.

Lala outlines three key priorities for improving prevention in women at risk for heart failure: early identification, closing implementation gaps, and driving policy and payment reform. She stresses that many existing risk tools are based on male populations, which leads to underrecognition of women’s risks. Since women more commonly present with heart failure with preserved ejection fraction (HFpEF) rather than systolic dysfunction, prevention strategies must reflect these differences. She also emphasizes that women often receive less therapy and attention than men, making equitable implementation critical to improving outcomes.

Gulati expands on this, highlighting the importance of sex-specific risk factors in refining risk assessment. Traditional risk calculators, heavily weighted by age, often underestimate the risks faced by young women, such as those experiencing adverse pregnancy outcomes like preeclampsia, gestational diabetes, or hypertension during pregnancy. 

These conditions elevate risks for both cardiovascular disease and heart failure within a decade, not just later in life. She also draws attention to peripartum cardiomyopathy and Takotsubo syndrome—forms of heart failure disproportionately affecting women—that are often underdiagnosed and lack effective preventive strategies.

Both experts agree that greater inclusion of women in clinical trials is essential for understanding how therapies apply across sexes. Gulati notes that intentional enrollment efforts have already begun to improve representation in heart failure research, shifting from historically poor female participation toward more balanced studies. This progress, she argues, demonstrates that with deliberate action, clinical trials can better capture sex differences, ultimately informing more effective and equitable care for women at risk of or living with heart failure.

In part 6 of this 7-part HCPLive Special Report, experts discuss the recently released ASPC/HFSA heart failure prevention statement.

Anuradha Lala-Trindade, MD

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