Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Heart Failure > Trials > Flashcards

Trials Flashcards

1
Q

CONSENSUS

A

NEJM 1987
RCT, enalapril (vs placebo) improved survival
-in >250 pts w/ NYHA IV HFrEF 6mo and 12 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SOLVD

A

NEJM 1992

  • RCT, enalapril (vs placebo) reduced HF hospitalizations, HF incidence and mortality
  • in > 4200 asymptomatic HF patient w/ EF < 35% taking diuretics/digoxin after 4 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CHARM-added

A

Lancet 2003

-Addition of candesartan (vs placebo) to ACEi in HFrEF, EF < 40%, reduced CV mortality and HF hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CHARM-alternative

A

Lancet 2003

  • Candesartan (vs placebo) reduced CV mortality (by 20%) and HF hospitalizations (by 40%)
  • in >2000 pts with HFrEF, who were intolerant to ACEi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

I-PRESERVE

A

NEJM 2008

-irbesartan did NOT reduced death or hospitalization, in pts w/ HFrEF, EF<45%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PARADIGM-HF

A

NEJM 2014

  • ARNI (vs enalapril 10 mg BID) reduced CV mortality, all-cause mortality, and HF hospitalization
  • in > 8000 chronic HFrEF pts, EF < 40% and < 35%, NYHA II-IV.
  • ARNI was well tolerated except for hypotension.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PIONEER-HF

A

NEJM 2019

  • ARNI (vs enalapril 10 mg BID) reduced NT-proBNP concentration
  • in > 800 pts w/ acute decompensated HF, at 4 and 8 weeks.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

EVALUATE-HF

A

JAMA 2019

  • ARNI at target dose 97/103 mg BID (vs enalapril 10 mg QD) did not show differences in change of aortic stiffness (measured with characteristic impedance via echo)
  • neither of them lowered aortic stiffness
  • in HFrEF < 40%, after 12 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PARAGON-HF

A

NEJM 2019

  • ARNI 97/103 mg BID (vs valsartan 160 mg BID) did NOT reduce HF hospitalizations/CVD death (rate ratio 0.87, 95%CI 0.75-1.01)
  • in > 4800 pts w HFpEF > 45%, NYHA II,III,IV, structural heart disease
  • However, ARNI was a/w less renal dysfunction (1.4% vs 2.7%, HR 0.5)
  • PARAGON was performed given positive results of PARAMOUNT (phase 2 trial in HFpEF).
  • FDA approved ARNI in HFpEF in Dec 2020 after analyzing PARAGON-HF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

OVERTURE

A
  • omapatrilat (a previous neprilysin inhibitor) is a/w higher freq of angioedema (OVERTURE trial).
  • Omapatrilat was a/w lower mortality and hospitalization as compared to enalapril, but produced too much angioedema!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MERIT-HF

A

Lancet 1999

  • metoprolol succinate 12.5-25 mg daily (vs placebo) reduced all-cause mortality (by 34%), all-cause hospitalizations, and CV events
  • in ~4000 pts w/HFrEF <40%, NYHA II-III
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CIBIS-II

A

Lancet 1999

  • bisoprolol (start dose 1.2510 mg daily (vs placebo) reduced all-cause mortality
  • in HFrEF < 35%, NYHA III-IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

COPERNICUS

A

Circulation 2002

  • carvedilol (3.125 – 25 mg BID, uptitrated q2w) vs placebo reduced risk of death and HF hospitalizations (by 31%)
  • in > 2000 euvolemic pts w/HFrEF < 25%, NYHA III-IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

COMET

A

Lancet 2003

  • carvedilol 3.125-25 mg BID (vs metoprolol tartrate 5-50 mg BID) reduced all-cause mortality
  • in >3000 pts w/ HFrEF < 35%, NYHA II-IV
  • after 4.8 years
  • Largest and most well-known head-to-head trial of Beta blockers
  • Criticism: it used metoprolol Tartrate (instead of succinate).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

RALES

A

NEJM 1999

  • spironolactone 25-50 mg daily (vs placebo) reduced all-cause mortality (by 30%), SCD, and HF hospitalization
  • > 1600 in pts w/ HFrEF < 35%, NYHA III-IV
  • Aldactone a/w gynecomastia/mastalgia (10% vs 1%).
  • Only 10% of pts were on beta blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

EPHESUS

A

NEJM 2003

  • eplerenone 25-50 mg daily (vs placebo) reduced mortality in patients with acute MI (3-14 d) complicated by LV dysfunction (EF < 40%) and HF.
  • A lot more patients (than in RALES) were on beta blockers.
17
Q

EMPHASIS-HF

A

NEJM 2011

  • eplerenone (vs placebo) reduced risk of death (by 15%) and hospitalization
  • in > 2700 pts with HFrEF <30%, NYHA II.
  • 85% were on beta blockers (only 10% in RALES).
18
Q

TOPCAT

A

NEJM 2014

  • spironolactone 15-45 mg daily (vs placebo) did not reduce CV mortality, HF hospitalizations, of aborted cardiac arrests
  • in ~ 3400 pts w/ s/s HF with LVEF > 45%, as compared to placebo.
  • There was a small reduction of HF hospitalizations: lead to subanalysis in 2017: Eastern European (Russian/Georgian) vs North/South American subjects  Eastern European subjects likely were not taking medication (metabolites were undetectable, potassium did not vary).
  • Criticism: used broad ACC/AHA HfpEF definitions, so maybe included pts who had no HF and did not need med.
19
Q

V-HeFT

A

NEJM 1986

  • ISDN/hydralazine (vs prazosin and vs placebo) improved survival in >600 patients with HFrEF, EF<45%.
  • A subgroup analysis showed statistically significant benefit among self-identified black patients.
20
Q

V-HeFT II

A

NEJM 1991

  • enalapril improved survival compared to ISDN/hydralazine
  • in > 800 male pts w/HFrEF, EF<45%, already taking diuretics and digoxin.
21
Q

A-HeFT

A

NEJM 2004

  • ISDN/hydralazine (vs placebo) improved survival (40%) and hospitalization
  • in > 1000 blacks with HFrEF on ACEi/ARB/BB/diuretics
22
Q

DAPA-HF

A

NEJM 2019

  • RCT, dapagliflozin (10 mg QD) (vs placebo) +GDMT was a/w less CVD death/HF exacerbation (HR 0.7, 16.3% vs 21.2%) and all-cause mortality
  • after 18.2 months, in > 4700 pts with NYHA II-VI HFrEF < 40%, regardless of diabetes status.
23
Q

EMPEROR-Reduced

A

NEJM 2020

  • empagliflozin 10mg/d (vs placebo) +GDMT was a/w less CV death/ HF hospitalization (HR 0.75, 19.4 vs 24.7%), slower eGFR decline, and worse renal outcomes
  • in > 3700 pts w class II-IV HFrEF < 40%, regardless of diabetes status
24
Q

SUGAR-DM-HF

A

Circulation 2021

  • empagliflozin 10mg/d (vs placebo) +GDMT was a/w reduced LV end-systolic volume index by 6.0, reduced LV end-diastolic volume index by 8.2, no difference in global longitudinal strain (CMR), reduced N-terminal pro-BNP by 28%, no difference in KCCQ, 6MWT, or B-lines
  • in pts w NYHA II-IV HFrEF < 40% + T2DM or prediabetes
25
Q

DIG

A

NEJM 1997

  • digoxin (vs placebo) reduced hospitalizations (by 28%) but not mortality
  • in > 6000 pts w/HFrEF <45%
26
Q

SHIFT

A

Lancet 2010

  • ivabradine (vs placebo) reduced HF mortality and hospitalizations
  • in > 6000 pts with HFrEF < 35%, NYHA II-IV, w/ HF hospitalization in the preceding year, and resting HR>70 despite being on max-tolerated GDMT
27
Q

VICTORIA

A

NEJM 2020

  • vericiguat (target dose 10mg QD), as compared to placebo, was a/w lower death from CV causes (16.4% vs 17.5%) or HF hospitalization (HR 0.9, CI 0.8-1.0).
  • over 10.8 mo, among pts with high-risk HF (NYHA II-IV, EF <45%),
  • Vericiguat was a/w symptomatic hypotension in 9.1% (7.9% in placebo), and syncope.
28
Q

AFFIRM-HF

A

Lancet 2020

  • IV iron (ferric carboxymaltose, for up to 24 weeks) vs placebo reduced risk of HF hospitalizations without difference in CV death
  • in > 1100 pts w iron deficiency (ferritin < 100, transferrin sat < 20%) and LVEF > 50% stabilized after episode of ADHF
29
Q

ESCAPE

A

JAMA 2005

  • pulmonary artery catheter-guided therapy did not improve survival and increased adverse events, compared to clinical assessment-guided therapy
  • in >400 patients with ADHF (EF < 30%)
30
Q

PAC-MAN

A

Lancet 2005
-in critically-ill patients, pul artery catheter did not show benefit or harm, vs no catheter.
RCT.

31
Q

EVEREST

A

JAMA 2007

  • tolvaptan PO (vs placebo) did not reduce all-cause mortality, CVD mortality, of HF rehospitalization
  • in > 4000 patients with acute HF exacerbation, for 60 days
32
Q

DOSE

A

NEJM 2011

  • high-dose (2.5 x home dose) loop diuretics (vs home dose) was a/w better symptom improvement, while diuretic infusion is not better than intermitted diuretic boluses (but were less likely to require thiazide-like diuretics)
  • in 300 pts w/ ADHF
33
Q

ROPA-DOP

A

JACC 2018

  • furosemide infusion (vs bolus q12h) was a/w worse renal function (because infusion does not allow adequate re-equilibration of intra/extravascular volumes in congestion)
  • in 90pts w HFpEF >50% and ADHF
  • This was especially true for women, African Americans, and CKD.
  • Low dose-dopamine (3mcg/kg/min) had no impact on renal function.
34
Q

ROSE

A

JAMA 2013

  • neither low-dose dopamine (2 mcg/kg/min) nor low-dose nesiritide enhanced decongestion or improved renal function when added to diuretic therapy
  • in 360 pts w ADHF and renal dysfunction (eGFR 15-60)
35
Q

DAD-HF

A

2010

  • low-dose dopamine 5 mcg/kg/min + low-dose furosemide 5 mg/h x8h (vs high-dose furosemide 20mg/h x8h w/o dopamine) was a/w better renal function profile and less hypokalemia
  • in 60 pts w ADHF
36
Q

DAD-HF II

A

2014

  • high-dose furosemide 20mg/h (vs low-dose furosemide 5mg/h) was not a/w differences in hospital and post-discharge outcomes.
  • Addition of low-dose dopamine infusion was NOT a/w any benefits.
37
Q

OPTIME-CHF

A

JAMA 2002
-in ADHF, routine use of milrinone as adjunct to standard therapy was NOT a/w lower mortality (in hospital of at 60 days), or death/readmission.

-milrinone be harmful in ischemic HF, but neutral to beneficial in nonischemic CMP

38
Q

CHAMPION

A

2017

-PA pressure-guided HF management reduces morbidity and mortality in pts with HFrEF on GDMT

Heart Failure (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions