‘Prevent today, thrive tomorrow’ was the theme for the British Society for Heart Failure 28th Annual Meeting, held in London on 20th–21st November 2025. It centred placing prevention, early detection, and equitable access at the heart of contemporary heart failure (HF) strategy. Across audit data, guideline updates, and trial presentations, a consistent message emerged: earlier diagnosis, rapid optimisation of guideline-directed medical therapy (GDMT), and system-level reform are essential to improving long-term outcomes. The BSH Nurse Forum Author Board report report the meeting highlights.
National Audit: variation and inequality persist
Opening the meeting, Dr Suzanna Hardman (Consultant Cardiologist, Whittington Hospital, London) presented the latest data from the NICOR National Heart Failure Audit.1 Admissions have returned to pre-pandemic levels, but substantial regional variation remains. Ethnicity recording continues to be poor, limiting the ability to address disparities. Access to echocardiography — central to diagnosis and phenotyping — also varies significantly. Half of hospital admissions are now for patients without heart failure with reduced ejection fraction (HFrEF), reflecting the growing burden of heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Mortality remains higher among patients not managed on a cardiac ward, often linked to reduced access to diagnostics and specialist HF input. Addressing these inequities was framed as a key priority for service development.1
Modern service reform
An outline of the forthcoming Cardiovascular Disease Modern Service Framework, aligned with the NHS Long Term Plan2 was given to the meeting by Dr Jessica Randall-Carrick (General Practitioner [GP], Boroughbury Medical Centre, Peterborough). The MSF aims to reduce premature cardiovascular deaths by 25% over the next decade while tackling inequalities and unwarranted variation. Built on a cardiovascular–renal–metabolic model, the framework emphasises prevention, digital transformation, and community-based care. It is designed to evolve with emerging evidence, with publication expected in Spring 2026.
NICE Guideline updates: early and comprehensive therapy
Updates to chronic HF guidance from the National Institute for Health and Care Excellence (NICE) were summarised by Professor Abdallah Al-Mohammad (University of Sheffield and Sheffield Teaching Hospitals NHS Trust). For HFrEF, early initiation and up-titration of quadruple therapy remain central. Where ACE inhibitors cause cough, switching directly to an angiotensin-receptor neprilysin inhibitor (ARNI) rather than an angiotensin receptor blocker (ARB) is advised. The guidance also highlights caution in renal dysfunction, recommends iron monitoring in HFrEF, and confirms that ARNI initiation may be undertaken by non-specialists. In HFmrEF, four agents may be considered (excluding ARNIs), while in HFpEF, SGLT2 inhibitors and mineralocorticoid receptor antagonists (MRAs) now feature prominently.3 The updates reinforce rapid optimisation and seek to reduce therapeutic inertia.
Research momentum and early career success
Research was a defining feature of the meeting. Professor Roy Gardner (Consultant, Cardiologist, Golden Jubilee National Hospital, Clydebank) celebrated 12 years of BSH Fellowships and announced a new two-year multidisciplinary research fellowship which will be announced later this year.
The 2025 BSH Early Investigator Awards showcased high-impact work:
- Dr Sarah Birkhoelzer (Heart Failure and Imaging Fellow, University Hospital Dorset) presented the REVIEW Potassium study, identifying knowledge gaps in renin-angiotensin aldosterone system inhibitor (RAASi) prescribing and hyperkalaemia management among 300 clinicians. Observational data showed vulnerable patients admitted with hyperkalaemia often receive limited follow-up, whereas newly diagnosed HFrEF patients on RAASi had low hyperkalaemia rates and better outcomes. Structured post-discharge pathways were advocated.
- Dr Elton Luo (Cardiology Registrar, Hull University Teaching Hospitals NHS Trust) addressed underdiagnosed HF. Screening 662 patients prescribed loop diuretics without a documented HF diagnosis identified 157 new cases and coding errors, increasing recorded prevalence from 0.9% to 1.1%. Accurate clinical coding was highlighted as fundamental to epidemiology and service planning.4,5
- Dr Archana Ganapathy (Cardiology Research Fellow, Essex Cardiothoracic Centre, Basildon) presented preliminary data on bioimpedance analysis (BIA) in acute decompensated HF. Given limitations of biomarkers and imaging in fluid assessment, BIA may provide a pragmatic method to estimate dry weight. A 255-patient study is underway.6,7
Fellows and national studies
Updates from BSH Research Fellows reflected the breadth of UK HF research. The POTION study linked polypharmacy with frailty and comorbidity; cardiovascular drugs accounted for approximately half of prescriptions. A subsequent analysis demonstrated a 26% mortality difference between polypharmacy (5–9 drugs) and hyper-polypharmacy (>10 drugs).8,9 A national dataset study exploring HFpEF outcomes in anthracycline-treated patients is aiming to develop a risk stratification tool. Other projects addressed BMI and NT-pro BNP relationships, remote monitoring with HeartLogic™, and biomarker assessment of DCD (donation after circulatory death) hearts during ex situ perfusion.
Major trials and emerging data
Professor John Cleland (Honorary Senior Research Fellow, University of Glasgow) gave a useful session highlighting the work of the BSH Research Investigator Network and previewing key trials reporting in 2026.
Professor Henry Savage (Consultant Cardiologist, Essex Cardiothoracic Centre, Basildon) presented the QUAD-HF Study, which introduced a practical optimisation score for HFrEF. Points are allocated for each guideline-dictated medical therapy (GDMT) pillar, with weighting for achieving >50% target dose and a bonus when all four pillars are initiated.5 The prospective QUAD-HF Registry will enrol 4,000 patients with newly diagnosed HF and LVEF <50%.
Professor John McMurray (Professor of Medical Cardiology, University of Glasgow) reviewed several late-breaking studies, including the DAPA ACT TIMI 68 study. This showed that in-hospital dapagliflozin did not significantly reduce cardiovascular death or worsening HF at two months, although wider SGLT2 inhibitor data supports early initiation.10
25 in 25 – prevention across four nations
Updates from the BSH 25 in 25 campaign,11 which is being rolled out across the UK, were presented at the meeting.
England
Dr Rani Khatib (Leeds Teaching Hospital NHS Trust and National Specialty Advisor for Cardiovacular Disease [CVD] Prevention), outlined England’s approach to CVD prevention, highlighting HF as a largely preventable yet growing public health challenge driven by population ageing, improved survival post-myocardial infarction, and increasing metabolic and renal disease. A national CVD prevention database, covering 98% of GP practices, tracks key risk factors. Despite evidence that avoiding hypertension, obesity, and diabetes by the age of 45 can reduce HF risk by 85%, major gaps remain. There are two million people estimated to have undiagnosed hypertension, blood pressure and lipid targets are often unmet, and inequalities persist. Prevention is a central pillar of the NHS 10 year plan,2 integrating lifestyle and medical optimisation.
Scotland
Ms Kylie Barclay (Senior Policy Manager for Heart Disease and Hospital Cardiac Arrest, and Health Care Quality Improvement Director for the Scottish government) outlined Scotland’s work on CVD prevention. She noted that population health is declining after years of improvement, with CVD still a leading cause of premature death and widening health inequalities. Disease burden is projected to rise by 21% by 2043. In response, Scotland’s Population Health Framework prioritises prevention and improved life expectancy. The Cardiovascular Disease Risk Factors Programme, launched in 2024, targets five major risk factors and aims to reduce cardiovascular deaths by 20% over 20 years, focusing on underserved populations.
Nothern Ireland
Dr Patrick Donnelly (Consultant Cardiologist and Clinical Director of Research and Innovation, Ulster Hospital, and Northern Ireland lead for CVD prevention and rehabilitation) outlined the cardiovascular landscape in Northern Ireland, focusing on rehabilitation services, prevention, and secondary care. He highlighted workstreams aimed at better use of healthcare data, strengthened secondary prevention, and managing financial pressures. While the 2016 ‘Systems, not structures’ framework12 promoted integrated care and pilot innovation, progress was hindered by limited regional leadership, diagnostic constraints, and workforce pressures. Despite improvements in HF management, many initiatives lacked scale. Current priority programmes in HF pathways and cardiovascular prevention, alongside improved electronic care records, offer renewed strategic opportunity.
Wales
Dr Grethin Ellis (Royal Glamorgan Hospital, and Honorary Resident of the Welsh Cardiovascular Society) outlined major cardiovascular challenges in Wales, including poor data quality and a rapidly ageing population, with HF admissions projected to rise by 50% over 25 years. He highlighted the strong link between cardiovascular risk factors and social deprivation. National programmes such as ABCD Plus, the Diabetes Prevention Programme and the CVD Action Plan aim to improve early risk identification and prevention. Wales is expanding lifestyle and wellness initiatives, digital health innovation, and early detection. Despite progress, workforce shortages—particularly HF nurses—remain a critical barrier to improving outcomes.
Challenging cases in heart failure: primary care
A primary care perspective exploring key challenges and priorities in contemporary HF care, including diagnosis, GP coding, value based medicine, Quality and Outcomes Framework (QOF) incentivisation, frailty, end-of-life planning and applying trial evidence to patients with multimorbidity, was given at the meeting by Professor Raj Thakkar (GPSI cardiology, and President, Primary Care Cardiovascular Society) and Ms Nicole McKelvie (Co-finder and Chair of Heart Failure Warriors Northern Ireland). Rising HF prevalence was highlighted, driven largely by increasing multimorbidity, alongside the importance of emotional intelligence and understanding the patient perspective. Diagnostic delays remain common, particularly due to non-specific symptoms such as breathlessness and limited access to timely echocardiography.
A powerful highlight was Ms McKelvie’s personal testimony describing prolonged diagnostic delays, lengthy waits for repeat scanning and the lasting trauma of how her diagnosis was communicated. She detailed presenting to A&E with aa left ventricular ejection fraction of 5%, illustrating the profound human impact of system delays, and emphasised the role of cardiac rehabilitation in restoring confidence and quality of life. She also outlined the work of Heart Failure Warriors Northern Ireland, including peer support, advocacy, education and the ‘Welcome home’ programme pairing recently discharged patients with trained patient advocates.
Frailty featured strongly throughout the session. Professor Thakkar stressed routine use of the Clinical Frailty Scale, a ‘frailty first’ approach, early personalised care planning and timely end- of-life discussions. He emphasised aligning treatment with patient priorities, focusing on quality of life, functional independence and avoiding unnecessary admissions through individualised, dignified care.
Challenges beyond ejection fraction
This session brought together presentations on cardio-renal-metabolic (CRM) care, imaging in cardiac amyloidosis, and novel treatments for cardiomyopathies.
Professor Smeeta Sinha (Consultant Nephrologist, Salford Royal NHS Foundation Trust) gave an overview of chronic kidney disease (CKD) in the context of CRM care, explaining how this is fast becoming a UK public health emergency, with approximately 7.2 million people living with CKD, accounting for more than 10% of the entire population. It is cited as the 10th leading cause of premature death.13 Furthermore, HF, CKD, and type II diabetes are closely connected, with those living with type II diabetes five times more likely to develop HF and one in three going on to develop CKD. Given that patients with CKD at an increased risk of hospitalisation for HF, the relevance to the HF community is clear.
CKD is diagnosed by measuring estimated glomerular filtration rate (eGFR) or urinary albumin creatinine ratio (uACR), with an eGFR of <60 mL/min 1.73 m2 or an uACR >3 mg/mmol present for greater than three months, or if one more other marker of kidney damage is present (e.g. nephrotic syndrome or urinary tract symptoms).14 Despite this, patients at high risk of developing CKD are not undergoing routine testing, potentially delaying diagnosis and access to treatment and care.15 Again, this is relevant to those with an interest in HF given the evidence that early initiation of a SGLT2 inhibitor can improve HF outcomes and decrease the progression of CKD. CRM conditions are common and interlinked so it is imperative to move from providing siloed care to optimal, collaborative care.
The second presentation of the session was delivered by Mr Shaun Robinson (Consultant Clinical Scientist, Imperial College Healthcare NHS Trust) and Dr Carol Whelan (Consultant Cardiologist, Royal Free London NHS Trust). This looked at diagnosing cardiac amyloid, with a focus on echo findings and clinical red flags. Amyloidosis affecting the heart includes AL (light chain amyloidosis) and TTR (transthyretin), categorised as either wild type or hereditary. Clinical red flags include HFpEF, intolerance to ACE inhibitors and beta blockers, bilateral carpal tunnel syndrome, lumbar spinal stenosis, biceps tendon rupture and unexplained neuropathy.
Imaging modalities used in the diagnosis cardiac amyloidosis include echocardiography, cardiac magnetic resosnance imaging, and DPD scintigraphy, with echocardiography commonly being the first-line tool where suspicion of amyloid is raised. Focusing on echocardiography, Mr Robinson presented the British Society of Echocardiography guidance for transthoracic echocardiographic assessment of cardiac amyloidosis, outlining the pertinent findings. These include increased left ventricular relative wall thickness, low stroke volume, thickened atrial septum, right ventricular hypertrophy and reduced global longitudinal strain with relative apical sparing.16 The key message from this session was early diagnosis is essential for patients to get the most benefit from amyloid treatment, making careful history taking and prompt imaging essential.
Finally, Professor Perry Elliot (Chair of Cardiovascular Medicine, University College London) discussed novel treatments for cardiomyopathies. Now a focus for therapeutic innovation, Professor Elliot explained how different approaches to describing cardiomyopathy phenotypes has an impact on how they are treated. The European Society of Cardiology guidelines for the management of cardiomyopathies17 outlines morphological traits such as left ventricular hypertrophy or ventricular dilation, and functional traits such as ventricular systolic dysfunction or ventricular diastolic dysfunction. Using dilated cardiomyopathy with reduced ejection fraction as an example, treatment is guideline-recommended four pillar therapy and consideration of device therapy. Moving to a more personalised, tailored approach may lead to therapeutic regimes that not only manage symptoms but also target underlying genetic and molecular causes.
Universally challenged
The conference ended with a note of brevity with ‘Universally challenged’, a light-hearted quiz that pitted North against South. Chaired by Professor Andrew Clark (Consultant Cardiologist and Chair of Clinical Cardiology, Hull York Medical School), this multi professional quiz saw two teams comprising a cardiologist, a HF nurse and a pharmacist answering questions about all things HF. While Team South prevailed on the day, spirited audience participation ensured a lively and entertaining session.
Philip Poole Wilson Memorial Lecture – Awarded to Professor Theresa McDonagh
This year’s Philip Poole Wilson memorial award was presented to Professor Theresa McDonagh (Consultant Cardiologist, King’s College London) who delivered an inspiring and reflective lecture on her journey in HF. In her talk, ‘Heart Failure – the best of times’, she explored the evolution of HF management, highlighting both the challenges and achievements that have shaped contemporary care in the UK. She paid tribute to the late Professor Philip Poole-Wilson, founder of the BSH, acknowledging his lasting impact on the field.
Professor McDonagh emphasised the importance of the NICOR HF audit in driving improvements in care delivery and outlined how evidence-based guidelines from the European Society of Cardiology continue to inform best practice. She also discussed emerging treatments, including polypill strategies in HFrEF, the role of research trials, reducing unwarranted variation, strengthening prevention, and developing sustainable multi-disciplinary HF management programmes. While recognising the significant progress made, she concluded that continued efforts are needed to further enhance the delivery of HF care across the UK.
The 2025 BSH meeting underscored prevention, early optimisation, and equity as defining priorities in heart failure care. National audit data exposed persistent variation, reforming services promises structural change, and guideline updates emphasise rapid, comprehensive therapy. Coupled with a strong portfolio of investigator-led research and large-scale trials, the UK HF community appears well positioned to translate prevention-focused strategy into improved long-term outcomes.
The BSH Nurse Forum Author Board
BSH diary dates
- 19th – 20th November: BSH Annual Meeting 2026, QEII, London
- 5th – 6th April 2027: BSH MDT Meeting, Golden Jubilee, Glasgow
Conflicts of interest
None declared.
Funding
None.
References
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