The population of patients who undergo cardiac surgery is becoming older and more medically complex, and frailty is increasingly prevalent. Prehabilitation is a multicomponent programme intended to better prepare these vulnerable patients for the stresses of surgery. Nonetheless, the effectiveness, implementation and effects on long-term outcomes of prehabilitation have not been clearly established. In particular, frailty might not be easily mitigated by prehabilitation.

Two studies now report that TET2-driven clonal haematopoiesis of indeterminate potential (CHIP) is associated with poor prognosis in patients with heart failure (HF) and preserved ejection fraction and that DNMT3A CHIP driver mutations promote dysregulated gene expression profiles that are associated with inflammation in monocytes in the setting of HF.

The link between migraine and cardiovascular disease is complex and involves overlapping mechanisms, such as endovascular disturbances. Challenges in measuring migraine, in distinguishing between causation and prediction, and in the understanding of clinical implications highlight the need for further research to guide treatment and cardiovascular risk assessment for the millions of individuals living with migraine.

In patients with heart failure (HF) with preserved ejection fraction and obesity, treatment with the glucagon-like peptide 1 receptor agonist semaglutide (2.4 mg) leads to large reductions in HF-related symptoms and physical limitations, improves exercise function and decreases body weight compared with placebo, according to the STEP-HFpEF trial.

An interaction between blood vessels and nerve fibres in the heart contributes to the decline in nerve density in the ageing left ventricle, potentially increasing susceptibility to arrhythmias.

The FIRE trial showed that complete revascularization improves outcomes in older patients with myocardial infarction (MI) and multivessel disease compared with culprit-lesion-only revascularization, whereas the MULTISTARS AMI trial reported that immediate multivessel revascularization is non-inferior to staged revascularization in patients with ST-segment elevation MI.