CardioExchange Archive

Regarding the studies to be vetted at the AHA meeting that focus on heart failure (HF), I expect several to be of great interest:

1. ASCEND-HF should provide data regarding the safety and efficacy of nesiritide. These data could be definitive, pro or con, and it will be fascinating to recover past thoughts and arguments and revisit those positions based on the new findings.
2. TELE-HF is a randomized trial of community care of HF patients after hospital discharge vs. use of an automated telephone algorithm to support care. Again, this may come closest to definitive evidence, pro or con, regarding the influence of telehealth.
3. EMPHASIS-HF — a randomized trial of an aldosterone antagonist added to standard HF therapy vs. placebo plus standard therapy in patients with NYHA Class II HF. The results of this study should allow us to understand whether or not there is a benefit when aldosterone antagonists are used for patients that are less ill from HF. Careful attention to any observed risks of therapy in this less-ill population will be important, as the concern regarding risk has limited the uptake for this approach even in those with more advanced HF.
4. ADVANCE: This study should provide the first data regarding a new LVAD platform (HeartWare), one that is presumed to be easier to implant and to have less morbidity. It could be a significant addition to the treatment of advanced HF if the data are positive.

1. EMPHASIS-HF —  a randomized trial of an aldosterone antagonist added to standard HF therapy vs. placebo plus standard therapy in patients with NYHA Class II HF. The results of this study should allow us to understand whether or not there is benefit when aldosterone antagonists are used for patients that are less ill from heart failure. Careful attention to any observed risks of therapy in this less ill population will be important as the concern regarding risk has limited the uptake for this approach even in those with more advanced heart failure.