Heart Failure Clinical Trial Tracker — Track HFrEF vs. HFpEF Trials and Emerging Mechanisms in 2026

Why heart failure trial monitoring matters

Heart failure affects over 6 million Americans and more than 64 million people globally, representing a $10B+ annual treatment market and one of the most active drug development pipelines in cardiovascular medicine. Despite decades of progress in HFrEF — where foundational therapies including ACE inhibitors, beta-blockers, MRAs, and sacubitril/valsartan (Entresto, Novartis) established guideline-directed medical therapy — HFpEF remained therapeutically orphaned until the SGLT2 inhibitor class demonstrated benefit across the ejection fraction spectrum.

The competitive landscape is now fragmenting across multiple mechanistic classes, with approximately 32 recruiting trials active on ClinicalTrials.gov in early 2026. Key signals driving monitoring demand:

• SGLT2 inhibitor expansion — dapagliflozin (Farxiga, AstraZeneca) and empagliflozin (Jardiance, Boehringer/Lilly) both approved across HFrEF and HFpEF, but combination and sequencing trials continue
• GLP-1 receptor agonist programs — semaglutide (STEP-HFpEF trial data) demonstrating symptom benefit in obese HFpEF patients, triggering a wave of competitive GLP-1/GIP combination trials
• Cardiac myosin modulator programs — omecamtiv mecarbil (Cytokinetics) demonstrated signal in GALACTIC-HF; aficamten and other next-generation myosin inhibitors now in Phase 2/3
• Gene therapy programs targeting SERCA2a and other cardiac calcium handling proteins entering early-phase trials
• Device and LVAD trials — including miniaturized assist devices, weaning protocols, and wearable hemodynamic monitoring
• Biomarker studies using NT-proBNP, hs-cTnT, and novel proteomic markers to stratify HFpEF phenotypes

Active Phase 3 heart failure trials (2026)

Key Phase 3 and pivotal heart failure studies currently recruiting or in startup:

NCT ID	Trial / Agent	Sponsor	Status
NCT07188805	Finerenone in patients with HFpEF (pediatric cohort, safety/PK)	Bayer	Recruiting
NCT06424288	Vicadrostat + empagliflozin vs empagliflozin alone in HFrEF	Boehringer Ingelheim	Recruiting
NCT06935370	Vicadrostat (BI 690517) + empagliflozin in HFpEF patients	Boehringer Ingelheim	Recruiting
NCT06307652	Balcinrenone + dapagliflozin vs dapagliflozin alone in HF	AstraZeneca	Recruiting
NCT07399587	Optimizing HFrEF with BaroStim + CardioMEMS device combination	Northwell Health	Recruiting
NCT05714085	Vericiguat safety/PK in pediatric HF patients	Merck Sharp & Dohme	Recruiting
NCT06128980	Withdrawal of HF treatment in patients with recovered LVEF	Herlev and Gentofte Hospital	Recruiting
NCT07489547	Medication withdrawal protocol in stable HFrEF with improved LVEF	Hospital de Clinicas de Porto Alegre	Not Yet Recruiting

What we monitor for heart failure

Our pipeline pulls directly from the ClinicalTrials.gov API every day. For a heart failure watch profile, you can configure:

• Condition keywords: "heart failure", "HFrEF", "HFpEF", "HFmrEF", "heart failure with reduced ejection fraction", "heart failure with preserved ejection fraction", "cardiac remodeling", "left ventricular dysfunction", "cardiomyopathy", "LVAD", "left ventricular assist device"
• Phase filter: Phase 1 only, Phase 2/3, or all phases
• Sponsor filter: Industry-sponsored only (for competitive intelligence) or all sponsors
• Status filter: Recruiting only, all active studies, or any status

The heart failure treatment landscape in 2026

SGLT2 inhibitors: approved across the spectrum, combinations being explored

Dapagliflozin (Farxiga) and empagliflozin (Jardiance) are now guideline-recommended across HFrEF, HFmrEF, and HFpEF — a landmark expansion of a drug class originally developed for type 2 diabetes. Both agents reduce hospitalizations and cardiovascular mortality, and their mechanisms (glycosuria, natriuresis, erythropoietin stimulation, and direct cardiac effects) remain only partially understood. The current clinical trial pipeline is exploring SGLT2 inhibitor combinations with MRAs, GLP-1 agonists, and novel agents, along with optimization studies in specific subpopulations including patients post-LVAD, post-transplant, and with cardiac amyloidosis.

GLP-1 receptor agonists: HFpEF and the obesity-HF nexus

Obesity-phenotype HFpEF — characterized by high BMI, inflammation, and relatively preserved EF — has emerged as a tractable target for GLP-1/GIP receptor agonists. The STEP-HFpEF trial demonstrated that semaglutide (Ozempic/Wegovy, Novo Nordisk) significantly improved functional capacity and symptoms in obese HFpEF patients. This has triggered a surge of competitive trials testing tirzepatide (Mounjaro/Zepbound, Eli Lilly) and next-generation incretin programs in HFpEF cohorts. Monitoring new trial registrations in this space is critical — the obesity-HF intersection is the fastest-moving area of HFpEF drug development.

Cardiac myosin modulators: HFrEF and HCM crossover

Omecamtiv mecarbil (Cytokinetics), a cardiac myosin activator, reduced the composite endpoint of heart failure events and cardiovascular death in the GALACTIC-HF trial despite a modest absolute benefit, establishing proof of concept for the myosin activation approach. Aficamten, a next-generation cardiac myosin inhibitor developed for hypertrophic cardiomyopathy (HCM), is being studied in HFpEF with preserved EF and non-obstructive physiology, representing a notable crossover from the HCM indication where mavacamten (Camzyos, Bristol Myers Squibb) was first approved. The mechanistic overlap between HCM and specific HFpEF phenotypes makes this one of the most scientifically interesting areas of the pipeline.

Gene therapy: early-phase programs targeting calcium dysregulation

Impaired sarcoplasmic reticulum calcium cycling — specifically, downregulation of SERCA2a (the cardiac calcium pump) — is a well-validated mechanism in both ischemic and non-ischemic HFrEF. Multiple gene therapy programs delivering AAV-packaged SERCA2a transgenes have entered or are approaching Phase 1/2 trials following decades of preclinical work. Additional targets include phospholamban inhibition and S100A1 upregulation. While still early-stage, gene therapy readouts in heart failure are among the highest-impact events in cardiovascular clinical development, and new trial registrations provide advance notice before data become public.

MRA and novel aldosterone pathway agents

Mineralocorticoid receptor antagonists (MRAs) — spironolactone and eplerenone — are established in HFrEF but have shown inconsistent benefit in HFpEF (TOPCAT trial). Finerenone (Kerendia, Bayer), a non-steroidal MRA approved for CKD/diabetes, is now being evaluated in heart failure cohorts given its differentiated receptor selectivity and favorable renal and potassium safety profile. Aldosterone synthase inhibitors represent another emerging mechanistic approach with early-phase trials registering patients in 2025–2026.

Device trials: LVAD, CRT, and wearable hemodynamics

Left ventricular assist devices (LVADs) — including the HeartMate 3 (Abbott) and next-generation miniaturized platforms — continue to generate trials focused on patient selection, weaning protocols, destination vs. bridge-to-transplant outcomes, and pump thrombosis mitigation. Cardiac resynchronization therapy (CRT) device optimization remains an active area, and wearable hemodynamic monitors (CardioMEMS, implantable pulmonary artery pressure sensors) are generating trials studying remote management protocols that reduce hospitalization rates. Monitoring device trial registrations requires tracking both drug and device study types on ClinicalTrials.gov.

Who uses heart failure trial monitoring

Cardiologists and academic heart failure centers

Advanced heart failure cardiologists at major academic centers — Mayo Clinic, Cleveland Clinic, UCSF, Northwestern, and similar programs — track new trial registrations to identify enrollment opportunities for their patients, understand the evolving landscape for guideline committee work, and stay current with emerging mechanistic classes. With heart failure trials now spanning pharmacology, devices, and gene therapy simultaneously, systematic daily monitoring has replaced manual ClinicalTrials.gov searches.

Pharma and biotech BD teams

Companies with cardiovascular franchises — AstraZeneca, Boehringer Ingelheim/Eli Lilly, Novartis, Cytokinetics, Bristol Myers Squibb, Bayer, and emerging biotechs — track competitor trial activity in real time. BD teams use new Phase 1 and Phase 2 trial registrations as early signals of mechanistic bets before data become public, informing licensing discussions and pipeline prioritization. In a field where multiple mechanism classes are converging on HFpEF simultaneously, competitive intelligence from trial registrations is among the most actionable pre-publication signals available.

Cardiovascular and healthcare investors

Investors tracking cardiovascular assets — particularly those with exposure to Cytokinetics, Rocket Pharmaceuticals, or emerging gene therapy companies — use heart failure trial monitoring as a leading indicator of clinical development trajectory. A new Phase 2 registration in a novel HFpEF mechanism often precedes a significant data readout by 18–30 months. Tracking these registrations provides portfolio-relevant intelligence that is publicly available but practically inaccessible without systematic monitoring.

Frequently asked questions

Can I track HFrEF and HFpEF trials separately?

Yes. On the Pro plan ($99/month), you can create multiple search profiles. You might set one profile for HFpEF-specific trials (including keywords like "preserved ejection fraction" and "HFpEF"), a separate profile for device and LVAD studies, and another for gene therapy programs — each delivering a focused daily digest targeted to a specific segment of the heart failure pipeline.

How current is the heart failure trial data?

Our pipeline fetches from ClinicalTrials.gov every morning. Studies posted or updated in the preceding 24 hours appear in that day's digest. For fast-moving areas like GLP-1/HFpEF trials, this means you see new registrations the same day they are posted — typically well before any press release or investor communication from the sponsoring company.

Does this cover device trials, not just drug trials?

Yes. ClinicalTrials.gov registers both drug and device intervention studies. Your heart failure watch profile can include device-specific keywords — "LVAD", "left ventricular assist device", "cardiac resynchronization", "CardioMEMS", "hemodynamic monitoring" — alongside pharmacologic keywords, giving you full-spectrum coverage of the heart failure pipeline.