Clinical trials update from European Society of Cardiology meeting 2008: TIME‐CHF, BACH, BEAUTIFUL, GISSI‐HF, and HOME‐HF

Abstract

This article provides information and a commentary on trials relevant to the pathophysiology, prevention and treatment of heart failure presented at the European Society of Cardiology meeting which was held in Munich, Germany from 30th August to 3rd September 2008. Unpublished reports should be considered as preliminary, as analyses may change in the final publication.The TIME-CHF study failed to show that BNP guided therapy was superior to usual care in patients with heart failure. The BACH study suggested that a new biomarker, MR-proANP, was as good as BNP for the diagnosis of heart failure in patients presenting with breathlessness. Ivabradine failed to reduce the incidence of cardiovascular events in patients with coronary artery disease and left ventricular systolic dysfunction in the BEAUTIFUL study, but patients with higher heart rates might have benefited. In GISSI-HF, n−3 PUFA reduced mortality and cardiovascular hospitalisation by a small amount compared to placebo in patients with chronic heart failure, but rosuvastatin had no effect on clinical outcomes. In the HOME-HF study, telemonitoring support failed to reduce the time to first re-hospitalisation or death, or days alive and out of hospital, compared with usual care. © 2008 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.Keywords: Randomised controlled trials; Heart failure 1. TIME-CHF: Trial of Intensified (BNP-guided) versus standard (symptom-guided) Medical therapy in Elderly patients with Congestive Heart Failure Presented by Hans Peter Brunner-La Rocca from Basel, SwitzerlandWhether BNP guided therapy can improve outcomes in patients with heart failure remains controversial [1][2][3]. The TIME-CHF study evaluated the efficacy of an intensified NT-proBNP-guided treatment strategy versus a standard, symptom guided approach. The study also assessed whether there was a difference in effect between patients aged ≥ 75 years and those aged 60-75 years [4].Four hundred and ninety nine patients with symptomatic heart failure, LVEF ≤ 45% and elevated NT-proBNP levels, were randomised to treatment in this single-blind, multicentre study, in which patients but not physicians were blinded to the treatment allocation. All patients were well treated according to current guidelines. The primary endpoint was freedom from hospitalisation over 18 months. The mean age of patients was 76 years and 35% were women.In the symptom-guided approach, patients were treated to achieve an NYHA class of II or lower. In the NT-proBNPguided strategy, the additional aim was to achieve NT-proBNP levels of b 400 pg/ml in the younger and b800 pg/ml in the older age group.Over the duration of the study, doses of ACE inhibitors, angiotensin receptor blockers and beta-blockers were increased more in the NT-proBNP-guided treatment group, irrespective of age. There was a similar, significant reduction in NT-proBNP levels and symptoms in both treatment groups.There was no difference in the incidence of the primary endpoint between the treatment g...

B-Type Natriuretic Peptides and Echocardiographic Measures of Cardiac Structure and Function

“…The greatest benefits are seen in younger patients with systolic heart failure, in whom reductions in mortality and heart failure events have been demonstrated with peptide-guided therapy (53)(54)(55).…”

Clinical trials update from the American College of Cardiology 2009: ADMIRE‐HF, PRIMA, STICH, REVERSE, IRIS, partial ventricular support, FIX‐HF‐5, vagal stimulation, REVIVAL‐3, pre‐RELAX‐AHF, ACTIVE‐A, HF‐ACTION, JUPITER, AURORA, and OMEGA

“…43 The results of GISSI-Prevenzione were supported by the finding of a reduction in mortality and death or cardiovascular hospitalizations in GISSI-HF. 2,44 However, these studies suggested little effect during the first year of follow-up.…”

“…However, the results of a recent systematic review of the effect of fish oil on the incidence of arrhythmias and mortality found that despite a reduction in cardiac deaths, fish oil (Ω‐3 fatty acids, n‐3 polyunsaturated fatty acids) supplementation had no effect on arrhythmias or all‐cause mortality . The results of GISSI‐Prevenzione were supported by the finding of a reduction in mortality and death or cardiovascular hospitalizations in GISSI‐HF ,. However, these studies suggested little effect during the first year of follow‐up.…”

Pleiotropic effects of statins in atrial fibrillation patients: the evidence

“…GISSI-HF concluded that a simple and safe treatment with n-3 PUFA can provide a small beneficial advantage in terms of mortality and admission to hospital for cardiovascular reasons in patients with heart failure. In the GISSI-HF sub-analyses of patients randomly assigned to rosuvastatin 10 mg daily (n = 2285) or placebo (n = 2289) using primary endpoints of time to death, and time to death or admission to hospital for cardiovascular reasons, 657 (29%) patients died from any cause in the rosuvastatin group and 644 (28%) in the placebo group (adjusted HR 1.00, 95.5% CI: 0.898–1.122; p = 0.943), with a final conclusion that rosuvastatin 10 mg daily did not affect clinical outcomes in patients with chronic heart failure of any cause 97. Whether higher doses have different effects need to be clarified.…”