Heart Failure Reframed: Calling Clinicians to Shift Focus to Prevention, With Muthiah Vaduganathan, MD, MPH

More than 6 million Americans are currently affected by heart failure, with prevalence expected to nearly double by 2050. Even with pharmacological advances, nearly 1 in 5 patients with heart failure die within a year.

Now, a roadmap from major organizations reframes heart failure as a preventable condition rather than an inevitable outcome, calling for the early management of risk factors like blood pressure, weight, and glucose levels decades before symptoms appear was recently published in a joint statement by the Heart Society of America and American Society for Preventive Cardiology.

Jointly published in the Journal of Cardiac Failure (JCF) and the American Journal of Preventive Cardiology, the statement, titled The Continuum of Prevention and Heart Failure in Cardiovascular Medicine, offer a shared framework where, for the first time, prevention was at the forefront of care. By breaking down silos between medical disciplines, the initiative promotes a continuous, multidisciplinary approach to care that applies to the whole person at every stage of the disease

“This is a wake-up call for the field,” said Martha Gulati, MD, MS, co-lead author. “We need to break down silos between preventive cardiology and heart failure care and create seamless strategies to identify and manage risk earlier. This needs to be a part of cardiovascular disease prevention.”

To celebrate Heart Failure Awareness Week 2026, which runs from February 8-14, PatientCareOnline sat down with Muthiah Vaduganathan, MD, MPH, cardiologist and clinical trialist at Brigham and Women’s Hospital at Harvard Medical School, to discuss the copncept of heart failure as a preventive disease and primary care’s role in disease management.

Primary Care’s Role in Heart Failure Prevention, Management Strategies

Patient Care: Why is it important to reframe heart failure as a preventative disease that begins with primary care?

Muthiah Vaduganathan, MD, MPH: Heart Failure, unfortunately, is diagnosed too late in many cases and often in the hospital, and at that juncture in time, prognosis is already quite limited, and disease progression actually occurs fairly rapidly, even with available therapies. Moving upstream is not only important in terms of the detection of heart failure at a broader level, but also in diagnosing heart failure at earlier stages of development, such that the institution’s implementation of therapies can be done properly, and we can have an eye to avoiding that first event, avoiding hospitalization in the first place.

Patient Care: What are some of the early, subtle signs that maybe a primary care clinician should think this could be heart failure when they see it?

Muthiah Vaduganathan, MD, MPH: Often, some of the earliest signs and including the hallmarks of heart failure include exertional dyspnea, as well as more subtle aspects like fatigue that may be written off as symptoms of simply aging. And while heart failure, instance and prevalence do certainly increase with age, healthy aging doesn't need to require the presence of heart failure. And some of these symptoms, if they are present, should prompt primary care clinicians to test for potential sub clinical risk. For instance, with natriuretic peptides, which are simple biomarkers, but can tell us a whole lot about cardiac stress, even in early stages. If those are abnormal, then further testing with specific imaging modalities, like echocardiography, can be done to understand if there are cardiac structure and functional abnormalities.

Patient Care: After referring a patient to cardiology, where do you see the ideal interplay between a cardiologist and their primary care clinician?

Muthiah Vaduganathan, MD, MPH: Heart failure is a long-term condition, and this is a disease state with undulating disease course, often punctuated by clinical events like hospitalizations. Often requires titration of medications, often requires close, laboratory and clinical follow ups, and so by no means does that initial handoff, that initial referral, truly mean you're giving up care of that patient. This is a collaboration in the management of the patient, and often that continued alliance between primary care clinicians and cardiologists can actually improve the patient experience by improving each of these touch points in care and keeping everything closely linked.

Patient Care: What have been the most common misconceptions you've heard or seen about the role of primary care within heart failure?

Muthiah Vaduganathan, MD, MPH:Initial touch points in care where patients are often reporting these subtle symptoms and may present with early signs. I think primary care clinicians have an essential role in diagnosing and detecting heart failure in its earliest phases, because this is the time point in which we can actually make a difference in the patient journey.

Patient Care:If you could wave a magic cardiology wand and have one sweeping change within primary care and their approach to these patients, what would that be?

Muthiah Vaduganathan, MD, MPH: Primary care clinicians have a lot on their plate. They screen for a number of chronic conditions. They regularly test patients for various laboratory abnormalities, but I think heart failure is also an important aspect that should be placed under the umbrella of primary care. We often think about screening for cancer, screening for lipid abnormalities or for diabetes, heart failure today can be screened for. There is already laboratory testing that are inexpensive, readily accessible across health systems and give you interpretable information about that individual person's risk of developing heart failure or even subclinical evidence of cardiac stress. So primary care clinicians should think about heart failure should be a part of that part of their daily kind of clinical practices, alongside screening for these other various chronic conditions.

Patient Care: If you were to recommend a short list of some of these screenings, what would they be?

Muthiah Vaduganathan, MD, MPH: Today we actually have comprehensive cardiovascular risk prediction algorithms such as the American Heart Association prevent equations that give you global assessments. It's difficult when we're screening for cardiovascular disease or forecasting risk of cardiovascular disease to focus on a particular aspect of cardiovascular risk and so scores like prevent, integrate a number of markers, a number of abnormalities in clinical and Clinical Medicine, to give you an integrative risk assessment. Some of those markers, I think, as you said, anti pro BNP and UACR would be the best markers that give you comprehensive assessments of both cardiac stress as well as endothelial function and endothelial health with natural peptides and albuminuria.

Patient Care: Any message to primary care or even cardiologists out there on heart failure as a preventable disease?

Muthiah Vaduganathan, MD, MPH: Heart failure is no longer just a disease of aging. It's no longer considered just the end-stage form of heart disease in which it has an inevitable course. Today, heart failure is a condition that can be detected early, that can be predicted and prevented with available therapies. If heart failure were to occur in an individual, whether reduced or preserved ejection fraction, we now also have available tools that can effectively manage the condition and prevent long term disease complications.

Editor’s Note: The above transcript has been lightly edited for grammar and clarity.

Poko L. Heart Failure Society of America and American Society for Preventive Cardiology Joint Statement Calls for a Shift in Heart Failure Prevention and Care | HFSA. Hfsa.org. Published 2025. Accessed February 10, 2026. https://hfsa.org/heart-failure-society-america-and-american-society-preventive-cardiology-joint-statement-calls-