HF Trials

HF Trials

1. HFrEF

   • BB
     • CAPRICORN
       • In patients treated long-term after an acute myocardial infarction complicated by left-ventricular systolic dysfunction, carvedilol reduced the frequency of all-cause and cardiovascular mortality 116 [12%] vs 151 [15%], and recurrent, non-fatal myocardial infarctions. 
       • ejection fraction of </=40% were randomly assigned 6.25 mg carvedilol (n=975) or placebo (n=984). Coreg dose increased to 25 mg in 4-6 weeks. In addition to ACE/ARB
     • CIBIS-II
       • Bisoprolol vs placebo in NYHA III/IV
       • Trial stopped early for significant survival benefit
   • ACE/ARB
     • V-HeFT-II
       • Mortality and Morbidity Reduction with Candesartan in Patients with ChronicHeart Failure and Left Ventricular Systolic Dysfunction
     • CONSENSUS-I
       • Enalapril vs placebo in NYHA IV
       • First to show improved survival with an ACE inhibitor
     • SOLVD-P
       • Enalapril vs placebo in NYHA II/III
       • First large simple trial in CHF
   • Entresto
     • PARADIGM-HF
       • class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either LCZ696 (at a dose of 200 mg twice daily) or enalapril (at a dose of 10 mg twice daily),
       • LCZ696 was superior to enalapril in reducing the risks of death and of hospitalization for heart failure. 
   • Aldactone
     • EMPHASIS-HF
       •  eplerenone with placebo
       • Eplerenone, as compared with placebo, reduced both the risk of death and the risk of hospitalization among patients with systolic heart failure and mild symptoms
   • Nitrates and Hydralazine
     • V-HeFT-I
       • H+I vs prazosin vs placebo in ∼NYHA II/III
       • Improved survival with H+I
   • Ivabradine
     • SHIFT
       • left ventricular ejection fraction <40%, New York Heart Association class II–IV, sinus rhythm, and heart rate ≥70 beats per minute. Ivabradine vs placebo
   • SGLT2 inhibitors
     • DAPA-HF
     • EMPEROR reduced

2. HFpEF

   • Aldactone
     • TOPCAT
       • heart failure and a left ventricular ejection fraction of 45% or more to receive either spironolactone (15 to 45 mg daily) or placebo.
       • treatment with spironolactone did not significantly reduce the incidence of the primary composite outcome of death from cardiovascular causes, aborted cardiac arrest, or hospitalization for the management of heart failure
   • Diuretics
   • SGLT2 inhibitors
     • EMPEROR preserved
   • Entresto
     • PARAGON-HF
       • sacubitril-valsartan versus valsartan in 4796 patients with NYHA class II to IV HF, LVEF ≥45 percent
       •  There were fewer hospitalizations for HF in the sacubitril-valsartan group; however, this finding was of borderline statistical significance (10 versus 12 per 100 patient years; RR 0.85, 95% CI 0.72-1.00). There were no significant differences between the two groups in death from cardiovascular causes (8.5 versus 8.9 percent; HR 0.95, 95% CI 0.79-1.16) or in all-cause mortality (14 and 15 percent).