Phenotype-guided approach for device-based therapies in heart failure

Device-based therapies have become integral in the management of heart failure (HF). By targeting structural or neurohormonal pathways, these therapies provide additional benefits beyond those provided by pharmacologic therapies or correct structural abnormalities that may not be amenable to drug therapy. However, a comprehensive framework for device selection tailored to individual clinical profiles and comorbidities has not yet been proposed, and many potentially effective approaches are underutilized among eligible patients in clinical practice. The availability of such a framework could help maximize the benefits of available therapies for the broad population of patients with HF. In this review, we explore the current role of device-based HF therapies in clinical practice based on available evidence from clinical trials and propose a phenotype-driven framework to guide device selection in HF patients with reduced and preserved ejection fraction. We also outline future directions, emphasizing opportunities to improve HF care.