Heart failure at the crossroads of climate change and environmental health: emerging risks, mechanistic insights, and future directions

Climate change is increasingly recognized as a major determinant of cardiovascular health, yet its impact on heart failure (HF) remains underexplored. Extreme temperatures, air pollution, and climate-related disasters represent critical stressors that can exacerbate HF incidence, hospitalizations, and mortality. In this scoped narrative review, we summarize and critically discuss evidence linking environmental exposures to HF outcomes, while distinguishing established epidemiological associations from mechanistic hypotheses and emerging areas of clinical translation. Pathophysiological mechanisms potentially involved include oxidative stress, systemic inflammation, hemodynamic instability, and autonomic imbalance, with disproportionate effects on vulnerable populations such as older adults, women, and socioeconomically disadvantaged groups. Recent evidence demonstrates that particulate matter, ground-level ozone, and wildfire smoke contribute to worsening HF outcomes, while extreme weather events disrupt healthcare delivery and continuity of care. This review summarizes the current evidence linking climate change and environmental exposures with HF, identifies key knowledge gaps, and highlights opportunities for prevention and adaptation strategies. A collaborative approach involving clinicians, researchers, public health systems, and policymakers is urgently needed to mitigate these risks and ensure equitable cardiovascular health in the era of climate change.