Monthly cardiology bulletin — October 14, 2026

This issue covers October 2 to October 14, 2026, the stretch between the previous issue and today. It was a fortnight of meetings rather than publications: the Heart Failure Society of America Annual Scientific Meeting in Phoenix (October 9–12), the EACTS Annual Meeting in Barcelona (October 7–10), and the World Congress of Cardiology held with the 81st Brazilian Congress of Cardiology in Rio de Janeiro (October 8–10). Nearly everything of note is a meeting presentation not yet published in a peer-reviewed journal, and each item says so. Interventional cardiology had a quiet fortnight ahead of TCT at the end of the month.

Clinical cardiology and prevention

1. Resistant hypertension: new ACC expert consensus decision pathway

[Guideline] [United States]
The American College of Cardiology published in JACC (online October 5) its 2026 expert consensus decision pathway for optimizing blood pressure care in resistant hypertension. It defines resistance as uncontrolled blood pressure (systolic ≥130 mm Hg or diastolic ≥80 mm Hg) despite three antihypertensives at maximally tolerated doses, or controlled pressure on four or more drugs. It proposes the RESIST framework: rule out pseudoresistance (adherence, technique, white-coat effect), exclude interfering substances, support lifestyle change, intensify and optimize medication, screen for secondary causes, and transfer to specialists when needed. It requires out-of-office measurement (home or 24-hour ambulatory), places renal denervation after drug optimization, and advises against cuffless devices until validation protocols exist.
Why it matters: this is a consensus document, not a guideline built on new evidence; even so, the pseudoresistance workup and the emphasis on out-of-office measurement are immediately applicable in Dominican practice, with no additional technology required.
https://www.jacc.org/doi/10.1016/j.jacc.2026.08.028
https://tctmd.com/news/acc-details-optimal-care-resistant-hypertension

2. More intensive blood pressure lowering reduces cardiovascular events with and without chronic kidney disease

[Meta-analysis] [International]
A systematic review and meta-analysis published in JAMA Cardiology on October 7 pooled 27 randomized trials with 88,830 participants, including recent trials such as ESPRIT, BPROAD, and STEP. Per 10 mm Hg reduction in systolic pressure, major cardiovascular events fell 15% overall (RR 0.85; 95% CI 0.81–0.89), 11% in patients with chronic kidney disease (RR 0.89; 0.81–0.99), and 16% in those without (RR 0.84; 0.80–0.88), with no significant heterogeneity (P = .26); in absolute terms, 4.2 events avoided per 1,000 person-years with chronic kidney disease versus 2.7 without. All-cause mortality fell 11% (RR 0.89; 0.83–0.95), an exploratory finding. Kidney failure was unchanged (RR 0.97; 0.84–1.11), but sustained eGFR declines of 30% or more were more frequent (RR 1.42; 1.28–1.58).
Why it matters: it supports intensive targets in chronic kidney disease as well, in line with KDIGO 2021, but with little information below 30 mL/min/1.73 m² and with an eGFR signal that demands creatinine and potassium monitoring.
https://doi.org/10.1001/jamacardio.2026.4445
https://www.pharmacytimes.com/view/intensive-bp-control-cuts-cv-risk-regardless-of-ckd-status

3. ACACIA-HCM: aficamten in non-obstructive hypertrophic cardiomyopathy, responder and safety data

[Meeting] [United States]
Cytokinetics presented additional prespecified analyses of the phase 3 ACACIA-HCM trial at HFSA on October 12 (aficamten versus placebo for 36 weeks in symptomatic non-obstructive hypertrophic cardiomyopathy; 517 patients randomized 1:1 outside Japan, according to the company's topline results release). On a new aggregate exercise response score (BEAP-RS), improvement was significant (P < .001) and correlated with KCCQ, NYHA class, and NT-proBNP; however, the proportion with a peak VO2 increase of at least 0.5 mL/kg/min was 45% versus 37% (P = .1, not significant). Fifty-three percent of treated patients responded in three or more domains versus 13% on placebo (P < .001). On safety, 27 patients (10.5%) on aficamten developed LVEF below 50% versus 2 (0.8%) on placebo, and serious heart failure events occurred in 12 patients (4.7%) versus 3 (1.2%); on aficamten, all occurred during titration or before week 12.
Why it matters: this is a manufacturer press release with a new composite score not externally validated and no figures for the primary endpoints; the clinically useful datum is safety, with LVEF drops below 50% far more frequent (10.5% versus 0.8%), which demands serial echocardiography during titration, hard to guarantee outside centers with easy echo access.
https://www.biopharmawatch.com/news/CYTK/cytokinetics-acacia-hcm-hfsa-2026
https://www.sec.gov/Archives/edgar/data/0001061983/000119312526372456/cytk-ex99_1.htm

4. Tovinontrine, a PDE9 inhibitor: mixed phase 2 results in heart failure with reduced ejection fraction

[Meeting] [United States]
Cycle-1-REF, a phase 2, randomized, double-blind, placebo-controlled, dose-finding trial of tovinontrine (CRD-750, Cardurion), an oral phosphodiesterase 9 inhibitor, was presented at HFSA (Phoenix, October 9–12). It was added to background therapy in 529 patients with heart failure and reduced ejection fraction (53 on 2.5 mg, 159 on 25 mg, 159 on 50 mg, and 158 on placebo). At 12 weeks, NT-proBNP changed −14.1% with 2.5 mg (P = .07), −10.8% with 25 mg (95% CI −20.6 to 0.1; P = .05), and −4.4% with 50 mg (95% CI −14.9 to 7.5; P = .45): the effect was largest at the lowest dose, a possible inverse dose-response that the investigators attribute to a myocardial cGMP threshold.
Why it matters: no dose achieved a statistically significant NT-proBNP reduction, NT-proBNP is a surrogate marker, and the available coverage does not detail safety data; it is a biological signal still to be confirmed, nothing that changes practice.
https://www.hcplive.com/view/tovinontrine-reduces-nt-probnp-in-hfref-may-have-greater-benefit-at-smaller-doses

5. SYNCHRONIZE-2: survodutide in obesity with type 2 diabetes

[Clinical trial] [International; presented in Milan on October 1, the day before the period]
Boehringer Ingelheim presented at the EASD meeting and simultaneously published in NEJM (DOI 10.1056/NEJMoa2607219) the phase 3 SYNCHRONIZE-2 trial: 755 adults with obesity or overweight and type 2 diabetes (baseline HbA1c 7.4%) randomized to weekly survodutide 3.6 mg, 6.0 mg, or placebo for 76 weeks. Weight loss reached up to 13.1% versus 3.1% with placebo; up to 79.3% lost at least 5% versus 32.7%; HbA1c fell up to 1.21 points versus 0.03; waist circumference fell 11.1 cm versus 3.5. Discontinuation for gastrointestinal effects was 18% versus 1.2%. The figures use the efficacy estimand; the co-primary endpoints were also met under the treatment-regimen estimand.
Why it matters: a manufacturer trial whose released figures use the efficacy estimand (assumes everyone stays on treatment) with nominal P values; in indirect comparison, weight loss appears smaller than with tirzepatide and retatrutide in similar populations, and cardiovascular outcomes await SYNCHRONIZE-CVOT; in our setting the problem remains access and price for the whole class.
https://www.ajmc.com/view/dual-agonist-survodutide-delivers-up-to-13-1-weight-loss-in-t2d
https://www.globenewswire.com/news-release/2026/10/01/3372565/0/en/x.html

6. HF STATS 2026: heart failure in the United States is heading the wrong way

[Publication] [United States]
The fourth edition of the Heart Failure Society of America's HF STATS report, published in the Journal of Cardiac Failure and released by the society on October 5, estimates that nearly one in four Americans will develop heart failure in their lifetime. About 7.7 million adults (around 3%) live with the disease, and 11.4 million are projected by 2050. Age-adjusted mortality rose about 37% between 2010 and 2023, and heart failure contributed to 452,573 deaths in 2023, 14.6% of the total. Hospitalizations rose among adults under 65 between 2010 and 2022, and between 2001 and 2020 crude mortality rose 121% among those aged 25 to 44 and 96% among those aged 45 to 64. Only 18% of more than 3 million patients with reduced ejection fraction receive recommended quadruple therapy.
Why it matters: these are registry and model estimates, not new primary data, but the gap between what the evidence recommends and what is prescribed is the transferable message for any system, including ours.
https://hfsa.org/hfstats
https://www.webull.com/news/15696265322578944

Interventional and structural cardiology

7. TAVI versus surgery: a Dutch registry tempers the advantage seen in DEDICATE-DZHK6

[Meeting] [Netherlands / Germany]
Presented at EACTS on October 8: 3,389 surgical aortic valve replacement patients in the audited Dutch national registry who met DEDICATE-DZHK6 eligibility were propensity-matched to the trial's 557 surgical and 654 TAVI patients. Surgery within the trial had more stroke or death than registry surgery (HR 1.63; 95% CI 1.02–2.26) and nearly three times the stroke rate (HR 2.96; 1.37–6.37), with no difference in mortality. Against registry surgery, trial TAVI did not replicate its advantage in stroke or death (HR 0.71; 0.44–1.14), though it kept lower mortality (HR 0.46; 0.24–0.87); a transportability analysis cut TAVI's absolute mortality advantage from 3.8 to 2.1 points.
Why it matters: a complex methodological exercise presented at a meeting, with possible unmeasured confounding and different event adjudication between registry and trial, and the EACTS panel itself noted that the trial results do not appear transportable to daily practice; the presenter called DEDICATE's surgical event rates unexpectedly high, its one-year results presented so far are mainly safety data with five-year efficacy still pending, while the 2025 European guideline has already lowered to 70 the age for considering TAVI.
https://www.tctmd.com/news/registry-analysis-tempers-difference-between-tavi-and-savr-seen-dedicate-dzhk6

Arrhythmias and electrophysiology

8. BEAT-AF: epicardial amiodarone patch does not prevent postoperative atrial fibrillation

[Clinical trial] [China; presented in Barcelona]
A pragmatic single-center randomized trial from China presented at EACTS on October 9: 502 patients (mean age 63, 33% women, 76% isolated CABG) undergoing cardiac surgery via sternotomy received two oxidized cellulose patches soaked in amiodarone 150 mg or in saline, placed over the atrial ganglionated plexuses before closure. Postoperative atrial fibrillation lasting at least 30 seconds within 5 days occurred in 13.4% versus 15.5% (adjusted OR 0.84; 95% CI 0.51–1.40), with no differences in AF burden, cardioversion, length of stay (7 days in both), stroke, or re-exploration for bleeding, and no in-hospital deaths.
Why it matters: the AF rate was far lower than expected and the trial ended up underpowered, the patches only partially covered the plexuses, and monitoring lasted 5 days; a neutral single-center result, presented at a meeting, that does not change current prophylaxis with beta-blockers and systemic amiodarone.
https://www.tctmd.com/news/amiodarone-patch-doesnt-prevent-postoperative-af-after-cardiac-surgery-beat-af

Cardiac surgery and imaging

9. VESALIUS-CV in patients with prior CABG and no MI: evolocumab reduces events

[Meeting] [International; sponsored by Amgen]
A subanalysis presented at EACTS on October 8: 1,432 VESALIUS-CV patients with prior CABG (a mean of 7 years earlier) and no prior MI, 88% on statins (71% high intensity), baseline LDL-C 3.0 mmol/L, randomized to evolocumab 140 mg every two weeks or placebo, with a median follow-up of 4.5 years. The four-point composite occurred in 18.4% versus 24.6% (HR 0.72; 95% CI 0.57–0.92; NNT 16), MI in 3.5% versus 8.0% (HR 0.45; 0.27–0.74), and ischemia-driven revascularization in 13.7% versus 19.8% (HR 0.68; 0.52–0.90). The three-point composite (HR 0.75; 0.53–1.06) and all-cause death (HR 0.82; 0.58–1.17) did not reach significance. LDL-C fell 56%.
Why it matters: a subgroup of a manufacturer trial, with a primary composite that includes revascularization and intervals crossing unity for the hard endpoints; still, it confirms that the bypass patient without MI is at very high risk and benefits from lowering LDL further, which in our setting can be done, at least in part, with high-intensity statin plus ezetimibe before considering antibodies.
https://www.tctmd.com/news/evolocumab-reduces-mace-patients-prior-cabg-no-mi-vesalius-cv

10. Heart transplantation with controlled donation after circulatory death: Spain, Italy, and the United States

[Meeting] [Spain / Italy / United States]
Four series presented at EACTS (two of them Italian). Spain (17 centers, 2021–2025): of 1,356 transplants, 314 used DCD donors, whose share rose from 1.4% to 34.9%; with shorter ischemic time (140 vs 206 minutes), similar primary graft dysfunction (22.4% vs 27.2%; P = .09), and equivalent one-year survival (adjusted HR 1.04; 95% CI 0.68–1.60). Italy (multicenter DCD.it study, 100 transplants at 10 centers under a mandatory 20-minute no-touch period): median warm ischemia 42.5 minutes, postoperative ECMO in 20.6%, severe left ventricular primary graft dysfunction in 15.7%, and 77.5% survival at 12 months; a single-center series from Bologna added 14 DCD transplants. United States (UNOS registry, 2,411 donors): donor coronary angiography, performed in 551, was not associated with one-year survival (HR 0.96; 0.66–1.41), and its use varied from 15% to 38% by region.
Why it matters: observational registry and center-series data, without randomization; the lesson is that the legal framework (Italy's mandatory 20-minute no-touch period, versus 5 minutes in Spain) shapes outcomes, and that DCD is already a third of activity in Spain, a model Latin America, with very low donation rates, should study.
https://tctmd.com/news/dcd-heart-transplant-experience-expands-globally-regional-differences-emerge

Cross-cutting

11. 2026 Brazilian heart failure guideline

[Guideline] [Brazil]
The Brazilian Society of Cardiology, through its Heart Failure Department, published on October 8 in Arquivos Brasileiros de Cardiologia (2026;123(10):e20260830) its new heart failure guideline, coinciding with the World Congress of Cardiology and the 81st Brazilian Congress in Rio de Janeiro (October 8–10). It uses GRADE methodology, with strong or weak recommendations and graded certainty of evidence. It drops the mildly reduced ejection fraction category (41–49%), now regarded as a transitional state: reduced is below 50% and preserved is 50% or above; it defines improved EF (baseline 40% or lower, a rise of at least 10 points, and follow-up above 40%), remission, and recovery. It keeps NT-proBNP below 125 pg/mL or BNP below 35 pg/mL as outpatient rule-out, strongly recommends genetic testing in probands with a potentially inherited cardiomyopathy phenotype and genetic evaluation of relatives of probands with a pathogenic or likely pathogenic variant, advises against routine serial echocardiography and routine global longitudinal strain, and places cardiac MRI as the reference standard for morphological and functional assessment.
Why it matters: it is the guideline closest to our epidemiological reality, with its own section on Chagas cardiomyopathy; treating EF 41–49% as reduced is a pragmatic bet that departs from ESC and ACC/AHA and simplifies quadruple therapy, but it loses nuance in a range where evidence for beta-blockers and ARNI is weaker.
https://abccardiol.org/en/article/brazilian-guideline-for-heart-failure-2026/

Upcoming meetings and dates

• October 31 – November 3: TCT 2026, San Diego, with 28 late-breaking studies announced.
• November: AHA Scientific Sessions 2026, Chicago.

*Cardiology Bulletin — October 2026*
Greetings, colleagues. What was verified from October 2 to 14 (HFSA, EACTS, and Rio).

❤️ Clinical and prevention
*Resistant hypertension: new ACC decision pathway*
Resistance with ≥3 drugs and BP ≥130/80; out-of-office measurement and stepwise escalation before renal denervation.
https://www.jacc.org/doi/10.1016/j.jacc.2026.08.028

*Lower blood pressure also protects the diseased kidney patient*
Meta-analysis of 27 trials (88,830 patients): each 10 mm Hg lower systolic cuts events 11% with CKD and 16% without; more eGFR declines.
https://doi.org/10.1001/jamacardio.2026.4445

*Aficamten in non-obstructive hypertrophic cardiomyopathy*
ACACIA-HCM: response in ≥3 domains in 53% versus 13% on placebo, but LVEF <50% in 10.5% versus 0.8%.
https://www.biopharmawatch.com/news/CYTK/cytokinetics-acacia-hcm-hfsa-2026

*Survodutide in obesity with diabetes (NEJM)*
755 patients, 76 weeks: up to 13.1% weight loss versus 3.1% (efficacy estimand); 18% discontinued for gastrointestinal effects.
https://www.ajmc.com/view/dual-agonist-survodutide-delivers-up-to-13-1-weight-loss-in-t2d

🩺 Interventional
*TAVI versus surgery: Dutch registry tempers DEDICATE*
3,389 registry surgical patients: trial surgery had nearly three times the stroke rate of registry surgery; TAVI's mortality advantage shrinks from 3.8 to 2.1 points.
https://www.tctmd.com/news/registry-analysis-tempers-difference-between-tavi-and-savr-seen-dedicate-dzhk6

⚡ Arrhythmias
*Epicardial amiodarone patch does not prevent postoperative AF*
BEAT-AF, 502 patients: 13.4% versus 15.5% with saline patches, no significant difference.
https://www.tctmd.com/news/amiodarone-patch-doesnt-prevent-postoperative-af-after-cardiac-surgery-beat-af

🔬 Surgery and imaging
*Evolocumab after prior CABG without MI*
VESALIUS-CV: 1,432 patients, MACE 18.4% versus 24.6% (HR 0.72), MI cut by more than half.
https://www.tctmd.com/news/evolocumab-reduces-mace-patients-prior-cabg-no-mi-vesalius-cv

*New 2026 Brazilian heart failure guideline*
Drops mildly reduced EF and uses GRADE.
https://abccardiol.org/en/article/brazilian-guideline-for-heart-failure-2026/

Full bulletin in your email
Full bulletin and audio: https://boletinesmedicos.com/en/cardiology/2026-10-14.html

Monthly cardiology bulletin — October 14, 2026
Eleven verified items from JACC, JAMA Cardiology, NEJM, the Journal of Cardiac Failure, Arquivos Brasileiros de Cardiologia, and the HFSA, EACTS, and World Congress of Cardiology meetings.
Three worth your time:
• Meta-analysis of 27 trials (88,830 patients): each 10 mm Hg lower systolic pressure cuts cardiovascular events 11% with chronic kidney disease and 16% without; the trade-off is more sustained eGFR declines, which need monitoring.
• VESALIUS-CV in bypass patients with no prior MI: evolocumab reduced the event composite from 24.6% to 18.4% (NNT 16) and MI by more than half; a subgroup of a manufacturer trial, with intervals crossing unity for hard endpoints.
• ACACIA-HCM: aficamten improves symptoms in non-obstructive hypertrophic cardiomyopathy, but LVEF fell below 50% in 10.5% versus 0.8%; serial echocardiography during titration is required.
Full bulletin, with a critical reading of each study and links to its sources:
https://boletinesmedicos.com/en/cardiology/2026-10-14.html
#Cardiology #HeartFailure #Cardiovascular #Hypertension #CardiacSurgery

Cardiology, Oct 2–14: each 10 mm Hg lower systolic BP cuts CV events 11% with CKD and 16% without (27 trials, 88,830 pts); evolocumab after CABG with no MI: MACE 18.4% vs 24.6%, NNT 16. Bulletin: https://boletinesmedicos.com/en/cardiology/2026-10-14.html