LAUSR

Over the last few years, one of the major advances of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) is the development and publication of an increasing number of thoughtful and influential position papers. No one group can take credit for this; it has truly been a collaborative effort, and I believe one that has paid off significantly. We must give credit to the leadership of the ESC itself, over many years, that set up and developed all manner of influential papers, starting of course at the top with the influential ESC guidelines, that now so dominate what practising cardiologists from Europe and beyond view as THE guide to the right things to do over the full range of cardiological practice. We must recognize the work of all the volunteers, who have sifted through voluminous evidence to bring these guidelines to us, and of course to the myriad number of volunteer writers, reviewers and members of the Committee on Practice Guidelines who have fine-tuned the guidelines so well. Beyond the formal guidelines which, because of their extensive work to well-drilled rules and regulations, can come out only very 4–6 years per topic, there is a larger number of position papers, position statements, consensus documents, expert updates etc. coming from the HFA. They have in common two things: they are not formal guidelines and they represent the coordinated work of the HFA in bringing together the considered views of its appointed experts on a range of new, emerging, contentious or complicated matters. The number of these papers have increased dramatically over recent years. This reflects, of course, the fact that the whole field of heart failure (HF) research and practice has expanded both in size and complexity in encompassing so much more of the basic science, clinical practice and co-morbidities of HF. This expansion of our papers has much to do with the restructuring of the committees of the HFA that commenced under the presidency of Frank Ruschitzka and continued under Petar Seferović, and that had the effect of invigorating and supporting considerably expanded work on novel aspects of HF care. Committees were formed looking at topics as diverse as acute HF, advanced HF, cardiac devices, cardiomyopathies and structural heart disease, diagnosis, education and digital health, exercise physiology and training, HF with preserved ejection fraction (HFpEF), patient care: delivery and management, regulatory affairs, surveys, registries and epidemiology and translational research and study groups focusing on major co-morbidities such as cardio-oncology, diabetes and hypertension, cardio-renal dysfunction, heart and brain, cachexia, sarcopenia and frailty, and lung disease and sleep disorders, peripartum cardiomyopathy as well as the liaison committees on HF National Societies and the HF Specialists of Tomorrow. This reorganisation and reinvigoration has led to a huge increase in the scientific output of the HFA, and it has been well received as shown by the many readers and downloaders of these articles. Most, but not all, are published in our flag-ship journal, European Journal of Heart Failure (EJHF). Some go ‘up’ to European Heart Journal, some across to ESC Heart Failure or our colleagues’ journals in North America. An analysis of the output and citations of the EJHF for articles published in the last 3 years show original research papers, especially randomised controlled clinical trials and important registry reports are high up in the citation list, with two generating over 100 citations in the short period since their publication.1,2 Amongst the ‘gold star’ papers which have received between 10 and 100 citations in the 1–2 years since they were published, we also see these HFA position papers. Papers such as an HFA position statement on type 2 diabetes mellitus and HF which has already received 88 citations since last year.3 Others similarly well-received include two reviews from the Acute HF Committee on ‘Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management’4 and on ‘Comprehensive in-hospital monitoring in acute heart failure: applications for clinical practice and future directions for research’.5 Others have reviewed advanced HF6 and right heart function in HFpEF.7 The Cardio-Renal Sub-Committee penned an extremely well-received article on the use of diuretics in HF with congestion,8 and from the committee on exercise physiology and training a paper on the role of cardiopulmonary exercise testing in clinical stratification in HF.9 There was also a report from our Cardiac Resynchronisation Therapy (CRT) Survey Group on contemporary usage of CRT in HF and its appropriateness.10 Other topical issues covered including cancer in HF by the cardio-oncology sub-committee,11 and a proposed taxonomy of heart and brain interactions complicating HF by the Heart and Brain Sub-Committee12 as well as a practical guidance paper from the Study Group on Peripartum Cardiomyopathy.13 There were also important papers from our translational scientist colleagues, including one from the Translational Research Committee on the autonomic nervous system as a therapeutic target in HF,14 and two from the affiliated Working Group on Myocardial Function, one covering an integrative translational approach to study HFpEF15 and a second on the innate immune system in chronic cardiomyopathy.16 The HFA has never looked stronger.