Three faculty cardiologists from the Duke Clinical Research Institute presented late-breaking research results and shared their insights via panel discussions and moderated posters as part of the European Society of Cardiology — Heart Failure (ESC-HF) meeting in Prague May 20-23.
PARAGLIDE-HF: Sacubitril-valsartan shows more benefit than valsartan in patients with worsening heart failure and ejection fraction greater than 40%
The combination medicine sacubitril-valsartan was associated with more clinical benefit compared to valsartan alone among patients with worsening heart failure and ejection fraction measurement greater than 40%, according to results from the PARAGLIDE-HF study shared in a late-breaking science session by DCRI’s Rob Mentz, MD on May 21.
The double-blind, randomized controlled trial assessed safety and efficacy of sacubitril-valsartan for patients with chronic heart failure and mildly reduced or persevered ejection fraction measurement greater than 40% following a recent worsening heart failure event. U.S. guidelines currently recommend health care providers consider the combination therapy for patients with chronic heart failure and mildly reduced or preserved ejection fraction, but its safety and efficacy for patients with ejection fraction greater than 40% was unknown.
“PARAGLIDE-HF provides important data regarding the safety and efficacy of sacubitril/valsartan in a diverse population of patients with heart failure and EF>40% when started in the hospital or within 30 days of a worsening heart failure event,” Mentz said. “In light of similar findings from PARAGON-HF, these data provide additional support for a potential treatment benefit of sacubitril/valsartan in HF with EF>40% (particularly in those with EF below normal).”
Study results were simultaneously published in the Journal of the American College of Cardiology.
“Effect of Torsemide vs Furosemide on Symptoms and Quality of Life in Heart Failure: The TRANSFORM-HF Trial”
A trial assessing the diuretics torsemide and furosemide for patients discharged after a hospitalization for heart failure showed no meaningful difference in the impact of patient symptoms or their quality of life, according to a late-breaking presentation at ESC-HF from DCRI’s Stephen Greene, MD, on May 22.
TRANSFORM-HF — an open-label, pragmatic, randomized trial of more than 2,800 patients across 60 hospitals in the United States hospitalized for HF, regardless of ejection fraction — examined differences in a strategy of torsemide versus furosemide, including patient-reported outcomes.
“Among patients with heart failure, a routine strategy of torsemide versus furosemide did not meaningfully impact patient symptoms or quality of life over 12-month follow-up,” Greene said. “For purposes of improving how our patients with heart failure feel, rather than focusing on use of a particular loop diuretic agent, clinical time is better spent focusing on ensuring the appropriate loop diuretic dose and prioritizing timely optimization of guideline-directed medical therapy.”
The results were simultaneously published in Circulation.
These insights build on additional results from TRANSFORM-HF first shared at the 2022 American Heart Association Scientific Sessions, which showed no difference between torsemide and furosemide in reducing deaths in patients with heart failure.
“Stellate Ganglion block for ventricular arrhythmias”
Ventricular arrhythmias — abnormal heartbeats that originate in someone’s lower heart chambers — can be serious. Ventricular tachycardia and ventricular fibrillation in particular can be both life threatening and resistant to treatment with conventional medication and devices. A new analysis from a multi-center registry of patients treated for refractory ventricular arrhythmia with stellate ganglion blockade revealed the treatment was associated with reduced ventricular arrhythmia burden and need for defibrillation, according to a late-breaking session presented by DCRI’s Marat Fudim, MD, MHS, on May 22.
Stellate ganglion blockade (SGB), a minimally invasive injection procedure performed at the patient’s bedside with ultrasound guidance from an anesthesiologist or cardiologist, creates a temporary sympathetic interruption to treat recurrent ventricular arrhythmia. An emerging treatment option, most data on SGB thus far have been from smaller cohorts. This study included 117 patients at Duke University Medical Center and Institute of Clinical and Experimental Medicine (IKEM), Prague, CZ who were 18 or older and had the procedure between 2016 and 2022.
“This is the largest registry of the intervention called stellate ganglion blockade for the management of ventricular arrhythmia,” Fudim said. “We are very excited to have the opportunity to collaborate with our European colleagues in the Czech Republic on this project. The data suggests that use of the nerve block is associated with a reduction of the ventricular arrhythmia burden. Given the ease and ubiquitous availability to perform it we hope to investigate it further in order to help improve the care of this highly morbid patient condition.”
Additional Presentations and panel discussions featuring DCRI faculty at ESC-HF included:
Marat Fudim, MD, MHS
- Impact of heart failure management using thoracic fluid monitoring from a novel wearable sensor: results of The BMAD Trial
- Autonomic dysfunction in HFrEF
- Unlocking the potential of baroreflex activation in heart failure patients
Stephen Greene, MD
- First intermediate analysis of the CARE-HK in heart failure registry
- Risk of safety events considered potential barriers to utilization of guideline-directed medical therapy among patients with worsening heart failure and ejection fraction 30% or lower
- Contemporary use of SGLT2i therapy among patients hospitalized for heart failure with reduced ejection fraction in the United States
- The urgency to implement GDMT
Robert Mentz, MD
- Two decades of research on iron deficiency in heart failure: Moving forward – knowledge gaps and ongoing trials
- Fundamentals in iron deficiency and IV iron