A new Yale-led study demonstrated that a drug treatment utilized for patients with chronic heart failure additionally enhances markers of poor prognosis in people who are hospitalized with acute heart failure. Scientists suggest that the study could pave the way for improving outcomes for acutely ill heart patients and potentially become the new standard of care for treating this serious condition.
Scientists conducted a randomized, double-blind clinical trial called PIONEER-HF to test whether the FDA-approved drug sacubitril-valsartan could improve outcomes. They tested almost 800 patients hospitalized with heart failure at 129 U.S. sites. Some patients were treated with
Over the time for testing of about two months, the scientists checked members’ blood pressure and other security parameters, for example, kidney function, and analyzed blood and pee samples.
Scientists discovered 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.
Corresponding author Eric Velazquez, M.D., the Berliner Professor of Cardiology at Yale School of Medicine said, “It worked to reduce NT-proBNP rapidly and to a greater extent than enalapril. There were multiple markers, including troponin T, a marker of heart cell injury, that suggested substantial improvement.”
“No significant differences between the two therapies in terms of safety, including an 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. 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.”
Scientists noted, “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.”
Velazquez said, “There are consistent results from both trials. 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.”
Other study authors are David A. Morrow, Adam D. DeVore, Carol I. Duffy, Andrew P. Ambrosy, Kevin McCague, Ricardo Rocha, and Eugene Braunwald.
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.