HEART FAILURE

Question 1

PARADIGM HF trial

Answer 1

Prospective comparison of Angiotensin Receptor-neprilysin inhibitor (ARNI) with Angiotensin converting enzyme inhibitor (ACEI)

Question 2

PARADIGM HF trial design

Answer 2

Compared the angiotensin receptor–neprilysin inhibitor (Entresto) with enalapril in patients who had heart failure with a reduced ejection fraction

Question 3

PARADIGM HF trial conclusion

Answer 3

Entresto was superior to enalapril in reducing the risks of death and of hospitalization for heart failure.

Question 4

ELITE II trial

Answer 4

Losartan Heart Failure Survival Study.

Question 5

ELITE II trial design

Answer 5

Patients were randomly assigned losartan (n=1578) titrated to 50 mg once daily or captopril (n=1574) titrated to 50 mg three times daily.
The primary and secondary endpoints were all-cause mortality, and sudden death or resuscitated arrest

Question 6

ELITE II trial conclusion

Answer 6

Losartan was not superior to captopril in improving survival in elderly heart-failure patients, but was significantly better tolerated

Question 7

COPERNICUS trial full name

Answer 7

Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS)

Question 8

COPERNICUS trial full name

Answer 8

Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS)

Question 9

COPERNICUS trial design

Answer 9

Randomly assigned to carvedilol or placebo in addition to usual HF therapy
Starting dose of carvedilol 3.125mg BID
Increased at 2-week intervals to target 25mg BID dose
Dose reduced or held as clinically appropriate
Followed every 2 months until end of study

Question 10

COPERNICUS trial design

Answer 10

Randomly assigned to carvedilol or placebo in addition to usual HF therapy
Starting dose of carvedilol 3.125mg BID
Increased at 2-week intervals to target 25mg BID dose
Dose reduced or held as clinically appropriate
Followed every 2 months until end of study

Question 11

COPERNICUS trial conclusion

Answer 11

Carvedilol reduced mortality by 35% (95% confidence interval, 19-48% reduction) and the annual placebo mortality in this study was 18.5%, suggesting an advanced heart failure population. Subgroup analysis showed a consistent benefit across all strata, and permanent treatment withdrawal was lower in the carvedilol group than in the placebo group, suggesting good tolerability of carvedilol.

Question 12

PRECISE trial

Answer 12

Showed benefit of Carvedilol in mild to moderate heart failure