LAUSR

The number of subjects living with heart failure (HF) has increased over the last decades because of demographic changes and, at least in part, because of the success of developments in modern cardiology. Improved acute care has dramatically reduced short-term mortality in acute coronary syndrome and other disorders, but is associated with an increase in the number of patients surviving the index event with some degree of cardiac dysfunction. Furthermore, medical and device-based therapies have substantially improved outcomes in patients with chronic stable HF with reduced ejection fraction, but hospital readmissions are still frequent and are associated with significant mortality.1 The risk for death is high during hospitalization for acute HF and is even higher during the immediate post-discharge period, which usually lasts up to 90 days and is known as the ‘vulnerable phase’.2 In this context, and considering the neutral results of several trials targeting acute HF with short-term in-hospital therapies, the optimal strategy for improving long-term outcomes in patients admitted with acute HF should be revisited. Particular attention should be given not only to the delivery of appropriate treatments during hospitalization, but, even more importantly, to ensuring the optimal transition of care during the vulnerable phase after hospital discharge. The identification of patients at particularly high risk for death during the vulnerable phase is challenging but of major clinical importance. Several scoring systems using multiple variables have been developed, but their implementation in clinical practice has been limited by their lack of accuracy and by their complexity. Compared with clinical parameters, cardiovascular biomarkers may indicate the occurrence of subclinical active processes that might