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CA125-guided therapy superior to standard care after acute HF hospitalization
Patients treated with a carbohydrate antigen 125-guided strategy after hospitalization for acute HF have lower risk for 1-year mortality or rehospitalization related to HF, according to data from the CHANCE-HF trial.
“In recent years, antigen carbohydrate 125, a widely available biomarker used for ovarian cancer monitoring, has emerged as a potential surrogate of fluid retention and inflammation activity in [acute] HF,” the researchers wrote.
To evaluate the role of carbohydrate antigen 125 (CA125) as a guiding tool strategy for patients after hospitalization for acute HF, the researchers conducted an open-label, randomized controlled trial between December 2011 and July 2014 in five academic centers in Spain.
Patients were randomly assigned to CA125-guided strategy (n = 187) or standard of care (n = 193) and were followed at outpatient HF clinic visits at 1, 6 and 12 months. The primary endpoint was the composite of all-cause mortality and/or readmission for acute HF at 1 year.
Standard-of-care treatment included use of ACE inhibitors, angiotensin II receptor antagonists, beta-blockers and antiarrhythmic drugs. The CA125-guided strategy involved keeping CA125 levels at 35 U/mL or less by means of diuretic dose optimization, enforcing use of statins and increasing monitoring visits. Overall, patients in the CA125-guided-strategy group had more monitoring visits than those in the standard-of-care group (5.97 vs. 5.23 visits/person-years; incidence rate ratio [IRR] = 1.14; P = .003) and had more furosemide-equivalent dose adjustments than the standard-care group.
In addition, the CA125-guided-strategy group experienced a reduction in the primary endpoint (66 vs. 84; P = .017). According to a Cox regression analysis by the researchers, the HR was 0.48 (P = .002) at 3 months, 0.64 (P = .028) at 6 months, 0.71 (P = .058) at 9 months and 0.72 (P = .049) at 12 months.
CA125-guided strategy also was associated with a reduction in recurrent hospitalizations for acute HF (0.4 vs. 0.85 events/person-years; IRR = 0.47; 95% CI, 0.35-0.63) and all-cause hospitalizations (0.67 vs. 1.06 events/person-years; IRR = 0.63; 95% CI, 0.5-0.8).
The reduction in risk for 1-year outcomes “was mainly driven by significantly reducing the rate of rehospitalizations,” the researchers wrote. – by Tracey Romero
Disclosure : One researcher reports receiving support from Ferrer and Servier to organize a CHANCE-HF researcher meeting in 2012 and 2013.