Viet Le, DMSc, PA-C, is a preventive cardiology PA at Intermountain Health and the former president of the Academy of Physician Associates in Cardiology.

Viet Le, DMSc, PA-C

Expert Perspectives: Top News in Heart Failure from HFSA Annual Scientific Meeting 2025

The Heart Failure Society of America Annual Scientific Meeting 2025,

 incorporating over 50 scientific sessions and hundreds of abstract presentations from leading researchers, saw a slew of exciting trial updates and insights from some of the best minds in cardiology.

During the conference, the editorial team at 

 sat down with several of these experts, collecting their thoughts on the most significant developments in 

’s approval of finerenone, the upcoming decision on aficamten, and the recent VICTOR, SUMMIT, and MAPLE- and ODYSSEY-HCM trials were highlighted.

The clinicians included in this summary are:

Ronald Witteles, MD, professor of cardiovascular medicine at Stanford University and co-director of the Stanford Amyloid Center and the Stanford Multidisciplinary Sarcoidosis Program

Barry Borlaug, MD, professor of cardiology at Mayo Clinic

Justin Ezekowitz, MD, professor of medicine at University of Alberta and cardiologist at the University of Alberta Hospital and Mazankowski Alberta Heart Institute

Ahmad Masri, MD, director of the Oregon Health & Science University Hypertrophic Cardiomyopathy Center and Knight Cardiovascular Institute Cardiac Amyloidosis Program

Javed Butler, MD, MPH, professor and chair of the department of medicine and Patrick H. Lehan Chair of Cardiovascular Research at the University of Mississippi Medical Center

Benjamin Hansen, MD, postdoctoral research fellow at the Department of Intensive Care at Copenhagen University Hospital - Rigshospitalet

Henri Roukoz, MD, associate professor of medicine, cardiovascular division, and section chief of electrophysiology, director of complex and congenital ablation at the University of Minnesota

Petra Mamic, MD, instructor of cardiovascular medicine at Stanford University Medicine

Stephen Greene, MD, cardiovascular disease fellow at Duke University Medical Center

Viet Le, DMSc, PA-C, associate professor of research at Intermountain Health

Milind Desai, MD, director of the center for hypertrophic cardiomyopathy and vice chair of education of the Heart Vascular Thoracic Institute at the Cleveland Clinic

I may be biased, but to me, ATTR amyloidosis is still the biggest story in heart failure. You’re talking about a disease that, a decade ago, most people hadn’t heard of. Maybe there would be one session every few years at the meetings, which was sparsely attended, but there was little interest, it was wildly underdiagnosed, and there were no therapies for it. Now we’re in an era where we realize this disease is not that rare, that if you look at the right patient populations, particularly older men with heart failure, thick hearts, and atrial fibrillation, you will pick up a lot of this. And it’s easy to diagnose; most patients can be diagnosed non-invasively. And now we have 3 FDA-approved treatments for ATTR 

, we have multiple other treatments approved for ATTR polyneuropathy, and multiple other agents in phase 3 trials. It is a super dynamic area, and it’s one that I think is particularly gratifying because it went from a fundamental understanding of the pathophysiology of the disease that led directly to the therapies. In the world of ATTR amyloidosis, the therapies have been designed to do exactly what they do, and in a rare thing in medicine, they pretty much all work.


The SUMMIT trial is probably the biggest news. It wasn’t a lot of events, it wasn’t a big trial, but it was a statistically significant improvement with a drug that was developed for weight loss, and it’s really ushering in a new era. HFpEF is a disease that’s driven by adiposity and everything that comes with that, such as visceral adiposity, pro-inflammatory and profibrotic effects, and many others. It’s opening the door for a lot of different drugs and potentially even devices that can target this cardiometabolic axis.


 2025 has been a pretty banner year for some trials: the VICTOR trial, being the largest recent clinical trial, has been quite important; the completion of DAPA-ACT, being the last real SGLT2 trial, showing that, when in combination with the meta-analysis, there is an advantage to starting those drugs early on. I think seeing the secondary analysis from some trials, such as the SUMMIT trial and the MRI of adipose tissue, is really interesting because it shows there’s a change in the structure and function of the myocardium that really is interesting. We’ve had so many great smaller trials as well, though, so it’s hard to pick one. There’s so much good stuff going on.


 Focusing on hypertrophic cardiomyopathy specifically, I think the 2 recent trials that were published, MAPLE-HCM and ODYSSEY-HCM, are really important findings in this space. MAPLE-HCM showed that beta blockers, as represented by metoprolol, are detrimental to patients with obstructive hypertrophic cardiomyopathy. This challenges a practice of 60-plus years of using beta blockers as first-line therapy. You don’t see reversals in approach frequently, because you don’t see these first-time agents challenged frequently. ODYSSEY-HCM, on the other hand, while it wasn’t a positive trial, showed that you have to be careful in your evaluation of patients with hypertrophic cardiomyopathy. You have to be mindful that you can’t just use 1 trial in a specific population and expand the drug treatment to other populations without investigation. This is a drug that was successful in obstructive hypertrophic cardiomyopathy with some safety issues that were managed and dealt with that wasn’t successful in non-obstructive HCM, and the safety signal was much worse. The trial wasn’t positive, but it reminded us that we have to be really careful when applying an extension of the current use of drugs, and we have to strive to stay with evidence-based medicine as much as we can with our newer therapies.


 The biggest story so far is that the field continues to move forward. We had a lot of positive data that has come out of either smaller primary studies or secondary analyses of larger studies with the obesity trials. That is becoming the solid, certified data that evidence generation needs, which has led to a lot of ongoing studies. The other is smaller studies that have shown that aldosterone modulation in ways other than MRA, like aldosterone synthase inhibitors, may be very helpful. And third, there’s a lot of compelling data that has come out about prevention of heart failure in high-risk populations.


 If I were to call out just one big news, it’s the role of vericiguat. I think that’s something of a hot topic right now, so I guess that’s something we really need to look further into to see its role in this population of well-treated outpatients with difficult-to-treat or advanced heart failure.


I would say how widely the SGLT2 inhibitors are being used and the increase in the indication to cover HFpEF patients. The second part is rhythm control and afib in heart failure, which is still a dominant thing from the EP standpoint.


This past year, we’ve had incredible studies published about gut microbiome in the context of heart failure, which have really put certain gut microbial metabolites on the map for their roles in heart failure. I think where we have come from 2024 to 2025 has really informed my research in a huge way.


There’s some things to pick from, but one thing that’s very notable is the FDA approval of finerenone as an evidence-based treatment for HFpEF, not just diabetic kidney disease anymore. The FINEARTS trial was presented last year, but FDA approval now really solidifies this in my mind that we have another pillar for HFpEF. SGLT2 inhibitors were the first definitively proven therapy for patients with HFpEF, and despite making up more than half of our heart failure population, we had no evidence-based therapy, no disease-modifying therapy to offer them. Now we have another therapy that I would argue strongly is definitively proven for improving hard clinical outcomes. I think we need to embrace that.

I’d also like to encourage people to think that it’s not an either-or when we talk about the “pillars of therapy,” and I don’t want to make the same mistakes that we made in HFrEF. We have multiple evidence-based therapies; you need to be willing to initiate them simultaneously and not get distracted with this specific medication sequence. People need both for prognosis comparable to cancer, not either-or.


GLP-1s are one of these unifying therapies across multiple diseases, and I think as we think back to 2025, we’re just having this confluence of heart failure from the diabetic space. Everyone is reporting clinical data trending towards benefit with GLP-1s. I think this is such a great jump-off point. So many different industry partners are looking into this, and before 2025, they were thinking about it. But now I think the community is much more aware. I look forward to seeing where those fit in the space of heart failure, but also in cardiovascular, kidney, and metabolic health.


I think the continued evolution of high-quality randomized controlled trial data in the context of cardiomyopathy, not just hypertrophic obstructive cardiomyopathy. Gene therapy is rapidly evolving, and you’re going to hear a lot about it. The other important thing is the utilization of novel artificial intelligence techniques to make early and precise diagnoses in these spaces. A rising tide lifts all boats, so they say; there’s a major tide that is lifting a lot of boats right now.

The quotes contained in this video summary were edited for clarity.

Editor's Note: Le reports disclosures with Pfizer, Novartis, Janssen, Idorsia, Amarin, and Lexicon. Greene reports disclosures with Amgen, Bayer AG, Boehringer Ingelheim, Bristol-Myers Squibb, AstraZeneca, Corcept, and others. Butler reports disclosures with Abbott Laboratories, Amgen, Bristol-Myers Squibb, Cytokinetics, Medtronic, Merck, and others. Masri reports disclosures with Pfizer, Ionis Pharmaceuticals, AstraZeneca, Cytokinetics, BioMarin, Akros, and others. Desai reports disclosures with Bristol-Myers Squibb, Medtronic, Cytokinetics, Edgewise, Viz-Al, and Tenaya Therapeutics. Borlaug reports disclosures with Amgen, Novo Nordisk, Eli Lilly, Edwards LifeSciences, Boehringer Ingelheim, AstraZeneca, and others. Witteles reports disclosures with Pfizer, Alnylam Pharmaceuticals, Bridge Bio, Janssen, AstraZeneca, and Alexian Pharmaceuticals. Roukoz, Hansen, Mamic, and Ezekowitz report no disclosures.

US FDA Approves KERENDIA (finerenone) to Treat Patients with Heart Failure with Left Ventricular Ejection Fraction ≥40% Following Priority Review. Bayer. July 14, 2025. Accessed October 3, 2025. 

https://www.bayer.com/en/us/news-stories/fda-approves-kerendia

Reddy YNV, Butler J, Anstrom KJ, et al. Vericiguat Global Study in Participants with Chronic Heart Failure: Design of the VICTOR trial. Eur J Heart Fail. 2025;27(2):209-218. 

Packer M, Zile MR, Kramer CM, et al. Interplay of Chronic Kidney Disease and the Effects of Tirzepatide in Patients With Heart Failure, Preserved Ejection Fraction, and Obesity: The SUMMIT Trial. J Am Coll Cardiol. 2025;85(18):1721-1735. 

Hegde SM, Wang X, Garcia-Pavia P, et al. Effect of Aficamten Compared With Metoprolol on Echocardiographic Measures in Symptomatic Obstructive Hypertrophic Cardiomyopathy: MAPLE-HCM. J Am Coll Cardiol. Published online August 27, 2025. 

Desai MY, Olivotto I, Abraham T, et al. Effects of Mavacamten on Cardiac Biomarkers in Nonobstructive Hypertrophic Cardiomyopathy: Insights From the ODYSSEY-HCM Trial. J Am Coll Cardiol. Published online August 25, 2025. 

Videos

This set of interviews collects perspectives from 11 leading clinicians in the heart failure field, cataloguing the biggest news from 2025.

Addressing Financial Toxicity in Heart Failure with Viet Le, DMSc, PA-C

Financial toxicity is a major concern in the healthcare industry, impacting patients’ ability to obtain and adhere to their prescribed medications. Guideline-directed medical therapy (GDMT) is the foundation of 

 care, decreasing hospitalizations, lowering mortality, and improving quality of life overall. However, HF-related expenses have risen in recent years, and research has attributed suboptimal adherence to medications to their cost.

Average out-of-pocket spending for HF is also substantially higher than for other cardiac comorbidities, due in part to its nature as a chronic disease characterized by multiple comorbidities with their own treatment costs. It is also heavily associated with hospitalizations, which may be expensive on their own, and can lead to compromised physical function.

To this end, Viet Le, DMSc, PA-C, associate professor of research and a preventative cardiology PA at Intermountain Health, gave a presentation on addressing and potentially circumventing financial toxicity at the 

Heart Failure Society of America Annual Scientific Meeting 2025

 in Minneapolis, MN. The editorial team at 

 sat down with Dr. Le beforehand to discuss his perspective on the state of the HF field and his advice to clinicians aiming to address this barrier.

In his presentation, Le urges clinicians to take action through pre-charting patients prior to visits, which he notes will allow clinicians the time they need to determine which patients may or may not be on GDMT.

“If you know that, then you know what you’re going to consider prescribing on a shared decision-making basis with the patient,” Le told 

. “That means you know what therapies are brand, they are not genetic, and they may or may not be approved, and you know which patients are Medicare, Medicaid, federal, or commercial, and that gives you a sense to be able to reach out to your pharmacist on the team and start the prior authorization process.”

Le also discussed the value of having specialized, expert pharmacists on a clinical team, suggesting clinicians offload much of the time-consuming work of prior authorization, letters of appeal or exception, and so on. Additionally, having a dedicated pharmacist or pharmacy technicians can allow for test claim running and getting key coverage document signatures while the patient is still physically present in the clinic, reducing the need for repeat visits.

Le’s presentation also highlights the importance of utilizing co-pay cards and vouchers for medications. Co-pay cards are particularly useful given their annual coverage “caps” ranging from $1000 to $4000. This bring co-pay to $0-$25 for 3 30-day or 1 90-day fill, after which point co-pay is back to “usual.” Le points out that this can save patients the $1000-$4000 a year.

Additionally, Le highlights 30-day vouchers, although their relatively higher monthly co-pay makes ensuring their 3 major conditions are fulfilled critical before patients make their decision. Vouchers primarily apply to medications which may have upfront side effects and require titration, as well as those which could require teaching for administration and monitoring of symptom benefits before full prescription.

“I don’t like that I have to use copay cards or vouchers, but I will use them, and I often use them just to get patients to feel comfortable with the therapies,” Le said. “That way, they’ll have a better idea whether or not this is something they truly can’t afford, and of the return on investment.”

Editor's Note: Le reports disclosures with Janssen, Pfizer, Novartis, Idorsia, Amarin, and Lexicon.

1: Sukumar S, Wasfy JH, Januzzi JL, Peppercorn J, Chino F, Warraich HJ. Financial Toxicity of Medical Management of Heart Failure: JACC Review Topic of the Week. J Am Coll Cardiol. 2023;81(20):2043-2055. 

2: Le V. Cost of Novel Heart Failure Therapies: Is the Juice Worth the Squeeze. Presented at the Heart Failure Society of America Annual Scientific Meeting 2025. Minneapolis, MN. September 26-29, 2025.

Le discusses methods by which clinicians can ease the financial burden of obtaining and adhering to medication for their patients.

Addressing Cardiovascular Health in MASH, with Viet Le, DMSc, PA-C

Cardiovascular disease is a leading cause of death in patients with 

metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH

). While liver damage is often the clinical focus, the overlapping metabolic risks, including obesity, 

, drive the threat of heart attacks, strokes, and 

With MASLD projected to affect more than 40% of US adults by 2050, tackling this dual burden has become a pressing priority in modern hepatology, as discussed by Viet Le, DMSc, PA-C, an associate professor of research and a preventive cardiology PA at Intermountain Health, at the 

2025 Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) conference

Patients with MASLD face heightened risks of coronary artery disease, cerebrovascular events, arrhythmias, and heart failure. Even among those without advanced fibrosis, vascular and metabolic changes can accelerate atherosclerosis and impair cardiac function, making cardiovascular risk assessment an essential part of MASLD and MASH management, not only for patients already presenting with metabolic comorbidities but also for those at earlier stages of liver disease.

“[Multidisciplinary] conversations are growing. It really takes champions, and it takes people who are passionate about patient care to make those conversations, because currently, we're all inundated in healthcare systems,” Le explained to 

He says that in order to reduce events and hospitalizations, providers must have conversations with the specialists next door to them. In his preventing cardiology clinic, Le says he has been discussing this with his colleagues in endocrinology, nephrology, and hepatology for years, but they still have not figured out a perfect approach.

Le goes on to reflect on the historical role weight loss has played in MASH management, describing obesity as a chronic disease with adipose pathology leading to liver inflammation and fibrosis.

“Now we have the GLP-1s, and what a fascinating area of a therapeutic molecule that now has dual incretin, they're looking at triple incretin, and that second incretin molecule has been interesting as to who is doing what with it, and what type of incretin they're looking at,” Le explained.

While GLP-1s have historically been known for their role in treating diabetes and facilitating weight loss, Novo Nordisk’s semaglutide (Wegovy) recently became the second FDA-approved MASH treatment.

“I think what it comes back down to is, is it a magic therapeutic molecule that just happens to treat all these things, or is it treating one central theme? And I think that's where we're at, is a better understanding coming back to adiposopathy,” Le said. “I think that’s a tying type of disease, and that's why we're seeing so many positive trials across the CKM space… As we look forward in time, I think we're going to see several more therapies come out through the GLP-1 space.”

Le P, Tatar M, Dasarathy S, et al. Estimated Burden of Metabolic Dysfunction–Associated Steatotic Liver Disease in US Adults, 2020 to 2050. 

Brooks A. FDA Approves Semaglutide (Wegovy) Injection 2.4 mg for Noncirrhotic MASH. HCPLive. August 15, 2025. Accessed September 19, 2025. 

https://www.hcplive.com/view/fda-approves-semaglutide-wegovy-injection-2-4-mg-for-noncirrhotic-mash

Le describes growing multidisciplinary conversations around CKM and why cardiovascular health needs to be a central focus of MASH/MASLD care.

Breaking Down 2025 ACC/AHA Hypertension Guidelines, with Viet Le, PA-C, DMSc

On August 14, 2025, the American Heart Association (AHA) and the American College of Cardiology (ACC) published a revised set of clinical guidelines for the detection and management of 

, based on decisions from the ACC/AHA Joint Committee on Clinical Practice Guidelines. Titled the “2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults”, the new document replaces the 2017 guidelines.

Aiming to collate all current knowledge in the field of high blood pressure to provide primary care and specialty clinicians with a comprehensive guide to managing hypertension, the document included detailed recommendations describing the processes of screening, treatment, and prevention of the condition.

 sat down with Viet Le, DMSc, PA-C, a preventive cardiology PA at Intermountain Health and the former president of the Academy of Physician Associates in Cardiology, to discuss the implications of these new guidelines and the impact they may have on the treatment landscape as hypertension becomes a greater burden for the public.

“The necessity of bringing 2025 forward in time was to reiterate that yes, stage 1 is 130-80, stage 2 is 140-90, and then we have elevated blood pressure regions,” Le told 

. “But most importantly, we all agree that the goal is less than 130 systolic, the goal is less than 80 diastolic.”

The revised document includes a table detailing new recommendations, including improved and increased screening for primary aldosteronism, avoiding atenolol, ARB, ACEi, nitroprusside, MRA, or direct renin inhibitors in pregnant patients with hypertension, and suggestions to prevent cognitive impairment and 

Another significant change made in the new guidelines was a recommendation that health care professionals utilize the Predicting Risk of CVD EVENTs (PREVENT) risk calculator, which was derived from data including a more diverse sample of racial and ethnic groups. Additionally, PREVENT expands the investigatory scope to total CVD risk, including 

Le also went on to discuss the broader implications of these guidelines. He expressed concern as to the practical ability of the US healthcare system to manage the burden of hypertension proactively.

"I think health systems need to rise up to this because, hey, I’m one person, but I work within the confines of a healthcare system that either supports me being able to do public health practice or not,” Le said. “And so, if we’re just happy with fee-for-service and sick care, we’ll never get to proactive value-based care and actually deliver health care. I would say that the US healthcare system in particular is not ready for that burden because we’re incentivized the wrong way.”

Editor’s Note: Relevant disclosures for Le include Novartis, Pfizer, Amgen, and Janssen.

Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online August 14, 2025. 

Jones, D, Ferdinand, K, Taler, S. et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. null2025, 0 (0). 

https://doi.org/10.1016/j.jacc.2025.05.007

Le discusses the implications of these new guidelines and whether the US healthcare system can manage the increasing public burden of hypertension.

Viet Le, DMSc, PA-C

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