Prevalence of high inflammatory risk across heart failure subtypes in Europe: a sub-analysis of the global POSEIDON study
J Muller-Ehmsen, K Broch, D I Bromage, N E Bruun, R Darwesh, N Girerd, P Karlstrom, M Lelonek, J Mathisen, M Metra, S Vestergaard Rosenlund, M SchouAbstract
Introduction
Inflammation has been implicated in the pathophysiology of heart failure (HF). High inflammatory risk, defined as high-sensitivity C-reactive protein (hsCRP) ≥2 mg/L, is associated with worse outcomes in this population. The global POSEIDON study, which included >18,000 individuals, assessed the prevalence of high inflammatory risk among individuals with atherosclerotic CV disease (ASCVD), HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF) or HF with reduced ejection fraction (HFrEF).
Purpose
To determine the prevalence of high inflammatory risk among individuals with HF enrolled in POSEIDON in Europe and to assess the characteristics of individuals with high inflammatory risk across HF subtypes.
Methods
Between 2023 and 2025, European investigators across 139 sites in nine countries (Czech Republic, Denmark, France, Germany, Italy, Norway, Poland, Sweden, UK) enrolled 7456 individuals in the POSEIDON study, including 4931 with HF. Individuals were enrolled during routine care visits. Individuals with infections, hospitalizations or unplanned visits in the past 60 days were excluded. The prevalence of high inflammatory risk and the characteristics of individuals with high inflammatory risk were assessed according to HF subtype (HFpEF, HFmrEF and HFrEF).
Results
Among the 4900 individuals with HF included in this analysis, 1421 had HFpEF, 961 had HFmrEF and 2518 had HFrEF. Overall, 2649 individuals (54.1%) had concomitant ASCVD. hsCRP ≥2 mg/L was observed in 576 individuals (40.5%) with HFpEF, 373 (38.8%) with HFmrEF and 994 (39.5%) with HFrEF. Compared with individuals with hsCRP <2 mg/L, those with hsCRP ≥2 mg/L had a higher body mass index, higher concentrations of N-terminal pro-B-type natriuretic peptide, higher levels of interleukin-6 and worse HF functional class, and were more likely to have hypertension, chronic kidney disease or a history of smoking (Table 1). This pattern was consistent across HF subtypes.
Conclusion
In this contemporary European population with HF, high inflammatory risk was highly prevalent. Approximately 4 out of 10 individuals had hsCRP levels ≥2 mg/L, regardless of HF subtype. The results were similar to those of the global POSEIDON analysis. This sub-analysis of European data highlights multiple clinical factors and comorbidities associated with increased inflammation regardless of HF subtype. These results underscore the considerable proportion of patients with HF who may be candidates for emerging anti-inflammatory therapies.