Heart failure in 2025: new insights, therapies, and clinical directions

Heart failure (HF) remains a major cause of morbidity and mortality globally, affecting between 1% and 3% of the total population. Despite the great efficacy of guideline-directed medical therapy (GDMT), patients still face high rates of rehospitalization and mortality. In the past year, emerging research has brought multiple up-to-date insights into HF treatment and substantial new options for clinicians. This review synthesizes landmark research and clinical progress in 2025 concerning epidemiological trends, causes, risk factors and treatments, aiming to update the evolving landscape of HF treatment. Significant progress is noted in pharmacotherapy (e.g., finerenone, tirzepatide) and device-based therapies [e.g., preCARDIA, cardiac resynchronization therapy with defibrillator (CRT-D)]. The completion of large-scale clinical trials, such as the DAPA ACT HF-TIMI 68 trial and the VICTOR trial, has offered solid evidence for the evolution in clinical practice. The emergence of novel devices offers promising alternatives and supplements to conventional therapies as well. Additionally, cutting-edge therapies like stem cell therapy have also revealed promising clinical prospects. Despite continuous therapeutic advances, substantial unmet needs in treatment and management still present a great challenge, necessitating further research to discover novel and better therapeutic strategies. Hence, major large-scale clinical trials initiated in 2025 are synthesized and anticipated as well. In brief, this review provides a timely update to guide clinical practice and future investigation.