Heart Failure at the Intersection of Metabolism and Nutrition: New Insights, New Opportunities

Heart failure has traditionally been conceptualized as a hemodynamic disorder driven by structural and functional cardiac abnormalities. Increasing evidence supports heart failure as a systemic, multi-organ condition characterized by profound metabolic dysfunction, influenced by nutritional status, that contributes to disease progression, reduced functional capacity, and poor clinical outcomes. These abnormalities include altered myocardial substrate utilization, impaired mitochondrial energetics, insulin resistance, skeletal muscle wasting, adipose tissue dysfunction, and systemic inflammation.

This session will examine heart failure through a metabolic lens, integrating state-of-the-science mechanistic insights with practical clinical considerations for members of the interdisciplinary heart failure team. First, we will explore mechanistic insights to highlight how disrupted energy metabolism influences heart failure phenotypes across the spectrum of ejection fraction. The second presentation will provide an overview of current and emerging concepts in the pathophysiology of cardiac cachexia, challenges in diagnosis and phenotyping, and recent advances in nutritional, exercise, and pharmacologic approaches. The third presentation will focus on the management of malnutrition in heart failure. The fourth presentation will discuss the latest evidence on sodium and fluid restriction in heart failure, and how these may differ during inpatient and outpatient encounters.

These sessions will provide tailored clinical guidance for a broad interdisciplinary team, including physicians, nurses (NPs, RNs), dietitians, and rehabilitation professionals. The session will conclude with a moderated panel discussion engaging speakers and audience members in discussion of controversies, knowledge gaps, and future directions for incorporating metabolic and nutritional strategies into comprehensive heart failure care.

Learning Objectives

• Describe key mechanisms of metabolic dysfunction in heart failure and their impact on symptoms, function, and outcomes.
• Recognize malnutrition and cardiac cachexia using interdisciplinary screening, assessment, and monitoring approaches across care settings, and their impact on advanced therapy considerations.
• Integrate evidence-informed nutritional, exercise, and pharmacologic strategies tailored to metabolic and functional status through coordinated, team-based care.