AIMS The Central/Eastern Europe (CEE) Quality of Care Centres (QCC) Survey evaluated the implementation of guideline-directed medical therapies (GDMT) and device use at discharge after heart failure (HF) hospitalization in CEE, where GDMT underutilization remains a concern. METHODS AND RESULTS Between March 2024 and January 2025, 2251 patients (mean age 70.0 years, 60.4% male) were enrolled at discharge from 21 centres across 12 CEE countries. The patient population included HF with reduced ejection fraction (HFrEF) (55.5%), HF with mildly reduced ejection fraction (15.3%) and HF with preserved ejection fraction (27.9%). In the total population, from admission to discharge there was a increase in the use of angiotensin receptor-neprilysin inhibitor (ARNI) (17.1% to 34.3%), beta-blockers (69.4% to 92.4%), mineralocorticoid receptor antagonists (MRA) (44.0% to 82.1%) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) (30.8% to 79.9%), with a reduction in angiotensin-converting enzyme inhibitor (ACEI) use (all p < 0.05). Similar trends were observed across HF phenotypes, including HFrEF (increased use of ARNI, 26.3% to 55.1%, beta-blockers, 69.8% to 95.3%, MRA 49.5% to 89.0%, and SGLT2I 36.2% to 79.8%, and lower ACEI use, all p < 0.05). At discharge, 53.5% of patients received quadruple therapy (63.9% with HFrEF), while ≥50% target doses of titratable drugs were achieved in 18.8% (17.8% in HFrEF). Predictors of GDMT underuse included older age, lower education, living alone, non-ischaemic HF, higher ejection fraction, chronic kidney disease, hypotension, hyperkalaemia, prolonged hospitalization, and residual oedema. Among eligible HFrEF patients, 21.3% were discharged with, or referred for implantable cardioverter-defibrillator, and 17.4% for cardiac resynchronization therapy. CONCLUSIONS The CEE-QCC Survey highlights substantial in-hospital GDMT implementation and up-titration, though device use remains limited. Targeted strategies are needed to enhance guideline implementation and ensure optimal HF care across the CEE region.

Introduction The 2019 ESC/EAS guidelines introduced stricter low-density lipoprotein cholesterol (LDL-C) targets, particularly for patients at high and very high cardiovascular (CV) risk. However, data on the implementation of these targets in real-world clinical practice—especially in countries with high/very high CV risk—remain limited. The DISCOVERY study aimed to assess LDL-C management, lipid-lowering therapy (LLT) use, and guideline adherence across multiple countries in Central and Eastern Europe and Central Asia. Methods This prospective, observational, multicenter study enrolled adult patients with hypercholesterolemia (HCL) from 10 countries grouped into three regions. Data was collected at baseline and after 12 weeks of follow-up. LLT patterns, LDL-C levels, target attainment (both investigator-defined and 2019 ESC/EAS-recommended), and physician adherence to guidelines were analyzed. Results A total of 6,447 patients were included; 53.2% were female, and the mean age was 60.5 ± 11.9 years. Most patients (66%) were in secondary prevention. At baseline, 36.8% had been treated with LLT. After the first visit, treatment was changed in 78% of patients, but only 42.4% received high-intensity statins and 9.3% received statin-ezetimibe combinations at follow-up. LDL-C target achievement was poor: only 5.6% of patients met the guideline-recommended LDL-C goals, compared to 45.5% who met physician-defined targets. Among patients with ASCVD, only 3.3% achieved guideline LDL-C targets. The most significant gap was observed between guideline recommendations and physician-set LDL-C goals. No significant difference in LDL-C target attainment was observed between specialists and general practitioners. Discussion The DISCOVERY study reveals suboptimal LDL-C control and low adherence to the 2019 ESC/EAS guidelines in routine practice across countries with high/very high CV risk. These findings highlight the urgent need for strategies to improve physician awareness, promote intensive LLT use, and close the gap between guidelines and clinical practice. A paradigm shift toward proactive LDL-C management is essential to reduce residual CV risk in these populations.

Natriuretic peptide (NP) uptake varies in Emergency Departments (EDs) across Europe. The ‘Peptide for Life’ (P4L) initiative, led by Heart Failure Association, aims to enhance NP utilization for early diagnosis of heart failure (HF). We tested the hypothesis that implementing an educational campaign in Western Balkan countries would significantly increase NP adoption rates in the ED.

BACKGROUND The 4S-AF scheme includes: stroke risk, symptoms, severity of burden, and substrate severity domain. AIM Our aim was to assess the adherence to 4S-AF scheme in patients classified according to stroke risk in post-hoc analysis of the BALKAN-AF dataset. METHODS A 14-week prospective enrolment of consecutive patients with electrocardiographically documented atrial fibrillation (AF) was performed in seven Balkan countries from 2014 to 2015. RESULTS Low stroke risk (CHA₂DS₂-VASc score, 0 in males or 1 in females) was present in 162 (6.0%) of the patients. 2,099 (77.4%) of patients had CHA₂DS₂-VASc score ≥3 in females or ≥2 in males (high stroke risk) and 613 (22.6%) had CHA₂DS₂-VASc score <3 in females or <2 in males. 75 (46.3%) of patients with low stroke risk and 1555 (74.1%) of patients with high stroke risk were prescribed oral anticoagulants (OAC). 2677 (98.6%) had data on European Heart Rhythm Association (EHRA) class. Among 2099 patients with high stroke risk, 703 (33.4%) had EHRA class ≥3. 207 (29.4%) of patients with EHRA class ≥3 and high stroke risk were offered rhythm control; 620 (55.2%) of individuals with first-diagnosed or paroxysmal AF with high stroke risk were offered rhythm control. Two or more comorbidities occurred in 1927 (91.8%) of patients with high stroke risk. CONCLUSIONS OAC overuse was observed in patients with low stroke risk, whilst OAC underuse was evident in those with high risk of stroke. The percentage of highly symptomatic patients with high risk of stroke who were offered rhythm control strategy was low.

To date, the prevalence of CHD worldwide is ∼9 per 1000 newborns, with substantial geographic variation. The latest knowledge in the world for the last 50 years about their origin, diagnosis and therapy has contributed to their care. Since adult patients with CHD now present increasing numbers at advanced ages, including the elderly, the term grown-up CHD no longer appears appropriate and was therefore replaced with adult CHD (ACHD) according to the ESC guidelines published in 2020 year. Due to medical, surgical, and technological evolutions over the past decades, >90% of individuals who are born with CHD now survive into adulthood. ACHD represent a challenge for clinicians. Despite optimal medical and surgical treatment, many will experience a progressive decline in cardiopulmonary function leading to advanced heart failure. Severe ventricular dysfunction and/or pulmonary hypertension may not be amenable to corrective repair. Their early recognition and follow-up in adolescence will contribute to better care for these patients. Importantly, the care for ACHD patients is a lifelong process and requires advance care planning strategies.

Symptom‐focused management is one of the cornerstones of optimal atrial fibrillation (AF) therapy.