FRESH-UP Study: Liberal Fluid Intake Versus Fluid Restriction in Chronic Heart Failure
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
Release Date: 04/15/2025
Top Takeaways From the 2025 ACC/AHA Acute Coronary Syndrome Guideline
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The 2025 ACC/AHA Acute Coronary Syndrome (ACS) Guideline clarifies diagnostic distinctions using electrocardiogram changes, troponin levels, and imaging tools such as coronary CT angiography and echocardiography in the emergency setting. Updates in lipid-lowering strategies and antiplatelet therapy reflect a more personalized approach to risk reduction and long-term care. These recommendations aim to streamline acute decision-making and improve outcomes across the ACS spectrum. In this interview, Drs. Sidney C. Smith Jr. and Michelle L. O'Donoghue discuss “Top Takeaways...
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Risk vs. Benefit in Chronic Total Occlusion Revascularization
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Chronic Total Occlusion Percutaneous Coronary Intervention (CTO PCI) is a procedure used to open coronary arteries that have been completely blocked for an extended period. It offers benefits like reduced angina and improved quality of life but carries risks such as vessel injury, heart attack, and procedural failure. Before considering CTO PCI, physicians typically optimize patients on anti-anginal medications—such as beta-blockers, nitrates, and calcium channel blockers—to manage symptoms and evaluate the need for intervention. In this interview, Drs. Anthony N. DeMaria and...
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LAAO vs. DOAC for Stroke Prevention in AFib
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While blood thinners like warfarin and direct oral anticoagulants (DOACs) remain the standard for stroke prophylaxis, left atrial appendage occlusion (LAAO) devices offer a non-pharmacologic alternative for patients at high bleeding risk. Recent trials have shown that LAAO can be as effective as anticoagulants in preventing stroke and may be a viable option, especially for patients who cannot tolerate long-term anticoagulation. In this interview, Drs. Anthony N. DeMaria and Dhanunjaya Lakkireddy explore the evolving landscape of stroke prevention in patients with atrial...
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Why Are They Still Dyspneic? Post PE Syndrome Workup and Management
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Persistent symptoms after an acute pulmonary embolism (PE) may indicate post-pulmonary embolism syndrome (PPES), a condition affecting up to 50% of patients. The most important consideration in managing PPES is to carefully evaluate and differentiate it from other potential causes of ongoing shortness of breath, particularly chronic thromboembolic pulmonary hypertension (CTEPH), which requires targeted treatment. How can clinicians best differentiate between PPES and other causes of persistent symptoms following an acute PE? In this interview, Drs. Dipti Itchhaporia and...
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Palliative Care Across the Spectrum of Biological Age in Heart Failure
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Palliative care supports heart failure patients by guiding complex medical decisions, managing symptoms, and enhancing quality of life. Despite being a guideline-recommended therapy, it remains underused—referrals are 45% lower for heart failure patients than for cancer patients with similar prognoses. Collaboration between cardiology and palliative care teams ensures that patients and caregivers receive goal-aligned care and the best possible quality of life. In this interview, Dr. Mary Norine Walsh and Ms. Jill A. Patton explore how palliative care can help patients across...
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ACCEL Lite: Hypertension Diagnosis and Management: Renal Denervation and Newer Agents on the Horizon
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Recent clinical trials demonstrate that intensive blood pressure lowering—targeting systolic levels below 120 mm Hg—can significantly reduce cardiovascular events and mortality, even among older adults, individuals with diabetes, and those with chronic kidney disease. This challenges the long-standing belief that looser blood pressure targets are safer for older patients, showing instead that with proper monitoring, tighter control offers substantial net benefits for most high-risk groups. In this interview, Dr. Alison L. Bailey and Dr. Keith C. Ferdinand explore the...
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What's the Best Time to Revascularize the Non-culprit Lesions in MVD
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Rapid emergency medical services transport to a percutaneous coronary intervention (PCI)-capable hospital is critical for timely intervention and management of life-threatening arrhythmias in ST-elevation myocardial infarction patients. Upon emergency room arrival, immediate transfer to the cath lab is essential to restore perfusion and improve both short- and long-term cardiovascular outcomes, as recommended by clinical guidelines. Interventional cardiologists must also be adept at managing culprit lesions in multivessel disease (MVD) and addressing complications like the no-reflow...
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Putting it All Together: Cardiogenic Shock Management in 2025
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Cardiogenic shock remains a critical, time-sensitive emergency with a high mortality rate. However, recent advances—particularly multidisciplinary, team-based strategies—have shown promise in improving patient outcomes. With the release of the , clinicians now have access to a streamlined, evidence-informed roadmap for early recognition, rapid stabilization, and escalation of care. In this episode, Drs. Glenn A. Hirsch and Shashank S. Sinha explore the latest strategies in cardiogenic shock management in 2025, emphasizing the how the new guidance integrates...
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Hemodynamic Assessment for Diagnosis and Treatment Selection in HFpEF
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Heart failure arises when the heart is unable to pump or fill with blood effectively. In the cardiac catheterization lab, we have the unique ability to directly measure the physiological abnormalities underlying this condition, making it the gold standard for diagnosing heart failure. While not every patient requires heart catheterization, it is often essential for those with heart failure with preserved ejection fraction (HFpEF). This is because noninvasive tests, which are commonly used, frequently fall short—providing false reassurance and leading to missed diagnoses. As a result, HFpEF...
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Primary Results From the SOUL Randomized Trial
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The SOUL trial demonstrated that in patients with type 2 diabetes (T2DM) and established atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or both, treatment with oral semaglutide significantly reduced the risk of major adverse cardiovascular events (MACE) compared to placebo—without an increase in serious adverse events. These findings position oral semaglutide as a compelling option with cardiovascular benefits consistent with those seen in injectable GLP-1 receptor agonists. In this episode, Drs. Deepak L. Bhatt and Darren K. McGuire explore how...
info_outlineFluid restriction is often recommended for heart failure (HF) patients to prevent congestion, but its benefits and safety are unclear. The FRESH-UP study is the first to show that strict fluid restriction does not improve health status for chronic, symptomatic HF patients and may increase thirst distress without reducing mortality, hospitalization, acute kidney injury, or medication needs.
In this interview, Roland RJ van Kimmenade, MD and Alison L. Bailey, MD, FACC discuss the impacts of the FRESH-UP study and how liberal fluid intake is safe for chronic HF patients, even enhancing their well-being. Providers are encouraged to reconsider universal fluid restrictions and adopt a more individualized approach.
RELATED REFERENCES:
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Herrmann JJ, Brunner-La Rocca HP, Baltussen LE, et al. Liberal Fluid Intake Versus Fluid Restriction in Chronic Heart Failure: A Randomized Clinical Trial. Nat Med 2025;Mar 30:[Epub ahead of print].