Healthcare system deficiencies should never be employed as justification for delivering sub-standard care to heart failure patients - Letter

Sep 29, 2026

Uploaded by jay

Letter responding to a viewpoint on serial assessment of left ventricular ejection fraction (LVEF) in heart failure management. The authors welcome agreement on biomarkers, emphasizing natriuretic peptides as complementary tools for detecting congestion and monitoring progression. They argue against using healthcare system shortcomings as a reason to provide sub-standard care, reaffirming the clinical relevance and guideline-based use of serial LVEF in selected scenarios and progression monitoring.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Response to viewpoint on serial LVEF assessment

Role of biomarkers and natriuretic peptides

Use of handheld and AI-enabled ultrasound devices

Clinical relevance and guideline recommendations for serial LVEF

Call to improve resources and maintain evidence-based care

Conflict of interest and author information

............................................................... ................................................................ ........................................................ ......................................................... doi:10.1002/ejhf.3772 Online publish-ahead-of-print 15 August 2025 Healthcare system deficiencies should never be employed as justification for delivering sub-standard care to heart failure patients. Letter regarding the article‘Serial assessment of left ventricular ejection fraction for the management of heart failure: Unnecessary and unrealistic?’ We read with interest the viewpoint by Palazzuoli et al. regarding serial assessment of left ventricular ejection fraction (LVEF) in heart failure management.1 While we found a disconnect between the title and the content of the viewpoint, we are pleased to note ................................................................ ............................................................... ......................................................... ........................................................ that the authors support the utilization of biomarkers for the detection and monitoring of heart failure, as advocated in our consensus statement.2 Indeed, natriuretic peptides represent a valuable tool for detecting congestion and monitoring disease progression, complementing rather than replacing comprehensive cardiac assessment. We concur with the insight of Thomas Lewis, who stated that ‘the very essence of cardiovascular medicine is the recognition of early heart failure’. In this context, natriuretic peptides play a crucial role, offering important diagnostic and prognostic value. Indeed, natriuretic peptides represent a valuable tool for detecting congestion and monitoring disease progression, complementing rather than replacing comprehensive cardiac assessment. We acknowledge the authors’ observation regarding the emerging role of handheld ultrasound devices and those with artificial intelligence (AI) capabilities in democratizing cardiac imaging. These technological advances are promising for enhancing bedside assessment and routine monitoring of patients with heart failure and may indeed facilitate more widespread access to cardiac function evaluation in resource-constrained environments. Much to our surprise, the authors appear to endorse the repetition of LVEF measurements—but only when conducted using handheld AI-enabled devices. However, it is not the technology itself that holds primary relevance, but rather the recognition of the dynamic nature of cardiac function. However, whilst we recognize some healthcare system constraints highlighted by the authors, such limitations should not serve as justification for providing sub-optimal care to patients with heart failure. The serial assessment of LVEF remains clinically relevant and evidence-based. It is also specifically recommended in specific scenarios, including post-optimization evaluation of guidelinedirected medical therapy, to confirm the candidacy for implantable cardioverterdefibrillator or cardiac resynchronization therapy after optimization of medical therapy and to monitor response to drug-device therapies. Serial assessment of LVEF is also recommended to monitor disease progression in patients with underlying cardiomyopathies or valve disease. These recommendations are supported by current guidelines for heart failure management. The evidence base for these assessments is robust and forms the cornerstone of contemporary heart failure care. While we appreciate the pragmatic concerns regarding resource allocation and waiting times, we must emphasize that © 2025 European Society of Cardiology. healthcare system deficiencies should never be employed as justification for delivering sub-standard care to heart failure patients. Rather than accepting limitations, we should advocate for improved resources, training, and infrastructure to ensure that all patien

FAQs

What is the letter’s main position about healthcare system deficiencies and patient care?

Healthcare system deficiencies should never be used as justification for delivering sub-standard care to heart failure patients.

How do the authors view biomarkers in heart failure management?

They support using biomarkers, highlighting natriuretic peptides for detecting congestion and monitoring disease progression as a complement to comprehensive cardiac assessment.

When do the authors say serial assessment of LVEF remains clinically relevant?

They state it is recommended in specific scenarios, such as post-optimization evaluation of guideline-directed medical therapy, and for monitoring progression in patients with cardiomyopathies or valve disease.

Sep 29, 2026

Uploaded by jay