Recent trials evaluate medications, management strategies for HF

SCOTTSDALE, Ariz. – Robin J. Trupp, PHD, ACNP-BC, CHFN, FAHA, of the University of Illinois, Chicago, reviewed recent studies in HF that examined strategies for reducing hospitalizations and mortality and the influence of lifestyle factors in the development and progression of the condition.

“In reviewing the materials – which consisted of over 100 possible trials to look at – I decided to break them into 3 groups,” Trupp told Cardiology Today. “The first group was studies that impacted the morbidity and mortality of patients with HF. The second was studies that impacted quality of life symptoms in that population. The third was studies that prevented the development of heart failure.”

The ”constant influx” of new research, coupled with delays in the development of guidelines, leads health care providers to put together their own management strategies for patients based on the evidence that is available.

“Practicing contemporary, evidence-based care is a challenge for all clinicians because there is a constant influx of new studies, not all of which are positive,” Trupp said. “While we have guideline-directed care that can lead us down the proper pathway for patient care, guidelines typically come out years after studies have been released. So it really is a challenge to stay on top of the latest and the greatest.”

Cardiology Today has put together a compilation of recent coverage on some of the studies reviewed by Trupp, as well as where to find more information about the other topics in the presentation.

PARADIGM HF

PARADIGM-HF compared sacubitril/valsartan (Entresto, Novartis) with the ACE inhibitor enalapril. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, was superior to ACE inhibition with enalapril for the reduction of death and HF hospitalization in patients with HF and reduced ejection fraction. Read more about the results of this trial and watch this video to learn more about new post-hoc analyses of PARADIGM-HF.

CHAMPION

Hemodynamically guided HF management was associated with approximately 50% fewer hospitalizations than standard HF management, according to findings from the CHAMPION trial. The prospective, single-blinded, randomized controlled trial was conducted to determine treatment options for 550 patients with HF and preserved ejection fraction. Specifically, the researchers aimed to test the hypothesis that hemodynamically guided management of HF can decrease decompensation that results in hospitalization. Read more about the results of this trial and watch this video to learn more about a sub-analysis of the CHAMPION-PHOENIX trial.

SERVE HF

Adaptive servo-ventilation had no significant impact on the primary composite endpoint of all-cause mortality, lifesaving CV intervention or unplanned hospitalization for worsening HF compared with medical management alone in certain patients with HF, according to results of the SERVE-HF trial. Read more.

SPRINT

Intensive BP management to achieve a target systolic pressure of 120 mm Hg reduced the risk for CV events, stroke and mortality in adults aged 50 years and older with hypertension, according to results of the SPRINT study. Read more about the results of this trial and watch this video to hear more about the clinical implications.

WEARIT-II

A wearable cardioverter defibrillator appeared to provide safe, continuous arrhythmia monitoring and automatic defibrillation for use as a bridging strategy, according to 18-month data from the WEARIT-II Registry. WEARIT-II is the first national registry of US patients prescribed the wearable cardioverter defibrillator (LifeVest, Zoll Medical). Read more.

For more information

Trupp also discussed the Atherosclerosis Risk in Communities study, the Women’s Health Study, the treatment of HF with ivabradine, which was approved last year, and a meta-analysis published by the European Society of Cardiology about the use of statins in HF. The Women’s Health Study found that usual walking pace is more strongly associated with lower risk for HF than total physical activity; the Atherosclerosis Risk in Communities study examined the role of modest alcohol consumption in the development of HF.

The Women’s Health Study can be found here: http://circ.ahajournals.org/content/133/Suppl_1/AMP46.abstract?sid=a96f363c-7bd1-4933-b14c-451deadd2d68&cited-by=yes&legid=circulationaha;133/Suppl_1/AMP46.

The Atherosclerosis Risk in Communities study can be found here: http://www.ncbi.nlm.nih.gov/pubmed/25602025

The meta-analysis about the use of statins in HF from the ESC can be found here: http://www.ncbi.nlm.nih.gov/pubmed/25802390.

Reference:

Trupp R, et al. Top 10 studies that will change your practice. Presented at: American Association of Heart Failure Nurses Annual Meeting; June 23-25, 2016; Scottsdale, Ariz.

Disclosure: Trupp reports no relevant financial disclosures.