Minimally invasive intervention strategies after myocardial infarction use state-of-the-art catheter systems that are able to combine mapping of the infarcted area with precise, local injection of drugs. To this end, catheter delivery of drugs that are not immediately pumped out of the heart is still challenging, and requires a carrier matrix that in the solution state can be injected through a long catheter, and instantaneously gelates at the site of injection. To address this unmet need, a pH-switchable supramolecular hydrogel is developed. The supramolecular hydrogel is switched into a liquid at pH > 8.5, with a viscosity low enough to enable passage through a 1-m long catheter while rapidly forming a hydrogel in contact with tissue. The hydrogel has self-healing properties taking care of adjustment to the injection site. Growth factors are delivered from the hydrogel thereby clearly showing a reduction of infarct scar in a pig myocardial infarction model. yield a further rise in mortality and morbidity. [ 1 ] New strategies are aiming at the prevention of the progression of postmyocardial infarction toward heart failure. Catheter-based drug delivery injection approaches [ 2 , 3 ] are substantially less invasive than for example surgical implantation of in vitro engineered tissues, [ 4 ] patches, [ 5 , 6 ] or drug delivery carriers. [ 7 ] Therefore, catheter-injection strategies are the method of choice with regard to clinical applicability. State-of-the-art is the NOGA catheter that enables precise control over the injection location via a special mapping system. [ 8 ] A 3D electromechanical image of the myocardium can be obtained using an ultralow magnetic-fi eld energy source and a sensor-tipped catheter to locate the catheter position. This mapping allows for the accurate identifi cation of normal and infarcted myocardium, and in this way, enables excellent spatial control over the injection of drugs. Generally, the injected drugs are substantially fast removed from the pulsatile heart when not delivered via a solid or gelated carrier material. Therefore, the

AimsThe prognosis of patients hospitalized for worsening heart failure (HF) is well described, but not that of patients managed solely in non‐acute settings such as primary care or secondary outpatient care. We assessed the distribution of HF across levels of healthcare, and assessed the prognostic differences for patients with HF either recorded in primary care (including secondary outpatient care) (PC), hospital admissions alone, or known in both contexts.Methods and resultsThis study was part of the CALIBER programme, which comprises linked data from primary care, hospital admissions, and death certificates for 2.1 million inhabitants of England. We identified 89 554 patients with newly recorded HF, of whom 23 547 (26%) were recorded in PC but never hospitalized, 30 629 (34%) in hospital admissions but not known in PC, 23 681 (27%) in both, and 11 697 (13%) in death certificates only. The highest prescription rates of ACE inhibitors, beta‐blockers, and mineralocorticoid receptor antagonists was found in patients known in both contexts. The respective 5‐year survival in the first three groups was 43.9% [95% confidence interval (CI) 43.2–44.6%], 21.7% (95% CI 21.1–22.2%), and 39.8% (95% CI 39.2–40.5%), compared with 88.1% (95% CI 87.9–88.3%) in the age‐ and sex‐matched general population.ConclusionIn the general population, one in four patients with HF will not be hospitalized for worsening HF within a median follow‐up of 1.7 years, yet they still have a poor 5‐year prognosis. Patients admitted to hospital with worsening HF but not known with HF in primary care have the worst prognosis and management. Mitigating the prognostic burden of HF requires greater consistency across primary and secondary care in the identification, profiling, and treatment of patients. Trial registration: NCT02551016