Despite therapeutic advances, chronic heart failure is still associated with significant risk of morbidity and mortality. The course of disease and responses to therapies vary widely between individuals with heart failure, highlighting the need for precision medicine approaches. Gut microbiome stands to be an important aspect of precision medicine in heart failure. Exploratory clinical studies have revealed shared patterns of gut microbiome dysregulation in this disease, with mechanistic animal studies providing evidence for active involvement of the gut microbiome in heart failure development and pathophysiology. Deeper insights into gut microbiome-host interactions in patients with heart failure promise to deliver novel disease biomarkers, preventative and therapeutic targets, and improve disease risk stratification. This knowledge may enable a paradigm shift in how we care for patients with heart failure, paving the path towards improved clinical outcomes through personalized heart failure care.EditorsEditor-in-ChiefValentin Fuster, MD, PhD, MACCCME EditorRagavendra R. Baliga, MDAuthorsPetra Mamic, MDMichael Snyder, PhDW.H. Wilson Tang, MDImportant DatesDate of Release: April 24, 2023Term of Approval/Date of CME/MOC Expiration: April 23, 2024