Nav: Home

Heart failure therapy improves outcomes for patients with acute illness

November 11, 2018

New Haven, Conn. -- A drug therapy used for patients with chronic heart failure also improves markers of poor prognosis in individuals who are hospitalized with acute heart failure, new Yale-led research shows. The findings suggest that the drug can improve outcomes for acutely ill heart patients and potentially become the new standard of care for treating this serious condition, the researchers said.

The study was published in the New England Journal of Medicine, and presented at the American Heart Association Scientific Sessions in Chicago on Nov. 11, 2018.

Acute heart failure, a condition in which the heart fails to pump blood efficiently, is the leading cause of hospitalizations for older adults. Affected individuals experience high rates of re-hospitalization and death. The standard of care, which consists of diuretics and medications that enhance blood flow, has remained largely unchanged for decades.

To test whether the FDA-approved drug sacubitril-valsartan could improve outcomes for individuals with acute heart failure, the research team conducted a randomized, double-blind clinical trial called PIONEER-HF. More than 800 patients hospitalized with heart failure at 129 U.S. sites were treated with either sacubitril-valsartan or the standard therapy, enalapril, an ACE inhibitor. Over the trial period of eight weeks, the researchers monitored participants' blood pressure and other safety parameters, such as kidney function, and analyzed blood and urine samples.

The research team found that in patients taking sacubitril-valsartan, levels of a key measure of heart failure severity -- NT-proBNP -- reduced more quickly than with the standard therapy. Evidence of improvement was observed as early as one week into the trial, they said.

"It worked to reduce NT-proBNP rapidly and to a greater extent than enalapril," said corresponding author Eric Velazquez, M.D., the Berliner Professor of Cardiology at Yale School of Medicine and PIONEER-HF principal study investigator. "There were multiple markers including troponin T, a marker of heart cell injury, that suggested substantial improvement."

Velazquez and his co-authors also reported no significant differences between the two therapies in terms of safety, including impact on renal function, blood pressure, and other indicators. "The results of this landmark study should help inform our basic approach to treating hospitalized patients with acute heart failure," said Velazquez. "Once acute heart failure is diagnosed, patients are stabilized, and a low ejection fraction is confirmed, sacubitril/valsartan should be started promptly to reduce NT-proBNP and reduce the risk of post-discharge heart failure hospitalization."

Combined with results of a previous trial, PARADIGM-HF, which showed the drug's effectiveness for patients with chronic heart failure, these findings could make sacubitril-valsartan the go-to standard of care for acute and chronic heart failure, said the researchers.

"There are consistent results from both trials," Velazquez said. "It is safe and there's a rapid outcome. If it becomes the standard, we are likely to reduce the risk of hospitalization for heart failure, and that will have a positive clinical impact and societal impact."
-end-
Other study authors are David A. Morrow, Adam D. DeVore, Carol I. Duffy, Andrew P. Ambrosy, Kevin McCague, Ricardo Rocha, and Eugene Braunwald.

PIONEER-HF was supported by Novartis Pharmaceuticals Corporation, which conducted the trial in collaboration with the Duke Clinical Research Institute and the Thrombolysis in Myocardial Infarction Study Group. Disclosure forms provided by the authors are available at NEJM.org.

Citation: New England Journal of Medicine

Yale University

Related Heart Failure Articles:

New hope for treating heart failure
Heart failure patients who are getting by on existing drug therapies can look forward to a far more effective medicine in the next five years or so, thanks to University of Alberta researchers.
Activated T-cells drive post-heart attack heart failure
Chronic inflammation after a heart attack can promote heart failure and death.
ICU care for COPD, heart failure and heart attack may not be better
Does a stay in the intensive care unit give patients a better chance of surviving a chronic obstructive pulmonary disease (COPD) or heart failure flare-up or even a heart attack, compared with care in another type of hospital unit?
Tissue engineering advance reduces heart failure in model of heart attack
Researchers have grown heart tissue by seeding a mix of human cells onto a 1-micron-resolution scaffold made with a 3-D printer.
Smoking may lead to heart failure by thickening the heart wall
Smokers without obvious signs of heart disease were more likely than nonsmokers and former smokers to have thickened heart walls and reduced heart pumping ability.
After the heart attack: Injectable gels could prevent future heart failure (video)
During a heart attack, clots or narrowed arteries block blood flow, harming or killing cells in the heart.
Heart failure after first heart attack may increase cancer risk
People who develop heart failure after their first heart attack have a greater risk of developing cancer when compared to first-time heart attack survivors without heart failure, according to a study today in the Journal of the American College of Cardiology.
Scientists use 'virtual heart' to model heart failure
A team of researchers have created a detailed computational model of the electrophysiology of congestive heart failure, a leading cause of death.
Increase in biomarker linked with increased risk of heart disease, heart failure, death
In a study published online by JAMA Cardiology, Elizabeth Selvin, Ph.D., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues examined the association of six-year change in high-sensitivity cardiac troponin T with incident coronary heart disease, heart failure and all-cause mortality.
1 in 4 patients develop heart failure within 4 years of first heart attack
One in four patients develop heart failure within four years of a first heart attack, according to a study in nearly 25,000 patients presented today at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure by Dr.

Related Heart Failure Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Climate Crisis
There's no greater threat to humanity than climate change. What can we do to stop the worst consequences? This hour, TED speakers explore how we can save our planet and whether we can do it in time. Guests include climate activist Greta Thunberg, chemical engineer Jennifer Wilcox, research scientist Sean Davis, food innovator Bruce Friedrich, and psychologist Per Espen Stoknes.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...