PRESS-NEWS.org - Press Release Distribution
PRESS RELEASES DISTRIBUTION

Clinicians urged to consider spironolactone in HFPEF despite TOPCAT results

TOPCAT fails to meet primary endpoint but post-hoc analysis shows benefit in patients from Americas

2014-05-18
(Press-News.org) Athens, 18 May 2014: Clinicians have been urged to consider using spironolactone in their patients with heart failure and preserved ejection fraction (HFPEF) after a post-hoc analysis of the TOPCAT trial showed benefit in patients from the Americas.

The research was presented today at the Heart Failure Congress 2014 in Athens, Greece. The Congress is the main annual meeting of the Heart Failure Association of the European Society of Cardiology.

Professor Bertram Pitt said: "We've had many studies showing that ACE inhibitors, angiotensin receptor blockers, beta blockers and mineralocorticoid receptor blockers reduce mortality and hospitalisations in patients with heart failure and reduced ejection fraction (HFREF). But no studies have found a benefit of these medications in HFPEF patients."

He added: "The results of TOPCAT are complicated. The trial failed to meet its primary endpoint but post-hoc analysis has shown that spironolactone was beneficial in patients from the Americas. I think individual clinicians around the world need to look at the data and decide for themselves. If I was a clinician I would use spironolactone in my patients with HFPEF."

TOPCAT randomised 3445 patients with HFPEF to receive spironolactone, a mineralocorticoid receptor antagonist, at a dose of 15-45mg per day or placebo on top of usual care. Patients were recruited from 270 medical centres in 6 countries. Nearly half of the patients were from Russia and Georgia, and the remainder were from the Americas which included Canada, the US, Argentina and Brazil.

After a mean follow up of 3.3 years, the primary endpoint - which was a composite of reduction in cardiovascular mortality, resuscitated cardiac arrest and hospitalisation for heart failure - was reduced but was not reduced significantly.1 It occurred in 320 of 1722 patients in the spironolactone group (18.6%) and 351 of 1723 patients in the placebo group (20.4%) (hazard ratio [HR]=0.89; 95% confidence interval [CI]=0.77 to 1.04; p=0.14).

One component of the primary endpoint, time to heart failure hospitalisations, was reduced significantly. It occurred in 12.0% patients in the spironolactone group and 14.2% in the placebo group (HR=0.83; 95% CI=0.69 to 0.99; p=0.04).

In patients treated with spironolactone there was an associated increase in serum creatinine and the rate of hyperkalemia doubled. But Professor Pitt said: "These alterations did not have adverse affects. There were no deaths attributable to hyperkalemia and no increase in renal failure."

He continued: "The overall results of the trial were negative in that the primary endpoint was not reduced significantly. But when we examine the results by geographical region they tell a different story."

Post-hoc analysis showed that patients recruited from Russia and Georgia had an extremely low placebo event rate that was not compatible with prior HFPEF studies. In contrast, patients from the Americas had an increased placebo event rate that was compatible with previous studies. In the Americas there was a significant reduction in the primary endpoint, including cardiovascular mortality and hospitalisations for heart failure.

Professor Pitt said: "The low placebo event rate in patients from Russia and Georgia was equal to that of patients with hypertension or another cardiovascular risk factor, not heart failure. We suspect that many of the patients from these countries did not have HFPEF, but had shortness of breath due to obesity or lung disease and were misclassified as heart failure. Whereas patients in the Americas did have HFPEF."

He concluded: "My view is that spironolactone works very well in HFPEF patients and our results were diluted by the inclusion of patients without HFPEF. Clinicians should look at our data and make their own decision about whether to offer spironolactone to their HFPEF patients. I would certainly use it given the lack of other treatments. Provided clinicians monitor potassium and renal function, the results of the TOPCAT trial show that spironolactone can be given safely to patients with HFPEF."

--

INFORMATION: Notes to editor

About the European Society of Cardiology The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

About the Heart Failure Association (HFA) The Heart Failure Association (HFA) is a registered branch of the ESC. Its aim is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.

For practical information about heart failure aimed at patients, families and caregivers, visit the HFA's Heart Failure Matters website.

Did you want to tweet about our congress? - if you do, please use the official #heartfailure2014 hashtag! Thank you

Information for journalists attending Heart Failure 2014

If you have any question or request regarding interview opportunities, please contact: ESC Press Office
Jacqueline Partarrieu
press@escardio.org
Tel: +33 6 22 83 45 76 (off site support number)

Heart Failure 2014 takes place in Athens, Greece, on 17-20 May 2014 at the MAICC Congress Center.

Look here for the current final programme: http://www.escardio.org/congresses/heart-failure-2014/Documents/fp-hf2014-web.pdf?hit=highlight-on

For full details of a session, have a look at the Scientific Programme & Planner: http://spo.escardio.org/default.aspx?eevtid=68&showResults=False

On-site Press registration process: Free registration applies to press representatives upon receipt of valid credentials and a fully completed embargo form. Credential: either your ID press card or letter of assignment with proof of 3 published articles Press registration is not available to Industry or its Public Relations representatives, event management, marketing or communications representatives The decision of the ESC Press Office is final regarding all press registration requests. When your registration as press will be validated you will be given a press badge and the press kit. The press working area is located in front of the registration desks. It features free wifi and a printer linked to a computer.


ELSE PRESS RELEASES FROM THIS DATE:

Cardiovascular diseases rise during Greek financial crisis

2014-05-18
Athens, 18 May 2014: Hospital admissions for cardiovascular diseases increased during the Greek financial crisis, according to two studies from Athens. The research was presented today at the Heart Failure Congress 2014, held 17-20 May in Athens, Greece. The Congress is the main annual meeting of the Heart Failure Association of the European Society of Cardiology. Dr Alexios Samentzas said: "Greece plunged into an economic crisis in 2008 and since then there have been rises in unemployment, wage reductions and a fall in standard of living. Previous studies have shown ...

Most emergency department 'super-frequent users' have a substance abuse addiction

Most emergency department super-frequent users have a substance abuse addiction
2014-05-17
DETROIT – A vast majority of so-called "super-frequent user" patients who seek care in the Emergency Department (ED) have a substance abuse addiction, according to a Henry Ford Hospital study. A patient is considered a super-frequent user who visits the ED at least 10 times a year. ED physicians have long theorized that patients who frequent the ED for their care have a substance abuse addiction. Few studies have actually measured the rate of addiction of these patients. The study's key findings: 77 percent of patients had a substance abuse addiction. 47 percent ...

Mount Sinai presents important findings at the 2014 American Urological Association Meeting

2014-05-17
(NEW YORK – EMBARGO May 17, 2014) Researchers at the Icahn School of Medicine at Mount Sinai will present several landmark studies at the 2014 American Urological Association (AUA) annual meeting May 17-19, 2014 in Orlando, FL, including data on an immune response in prostate cancer tumors, effects of paternal age on stimulated insemination live birth rates, issues of sexual function after cystectomy and a comparison of modalities for the treatment of benign prostatic hyperplasia (BPH). Meeting attendees will be able to view a live 3-dimensional video feed of a robotic ...

RELAX-AHF: Poor diuretic response associated with worse clinical outcomes

2014-05-17
Athens, 17 May 2014: Poor diuretic response is associated with worse in-hospital and post-discharge clinical outcomes, results of the RELAX-AHF trial reveal. The study also found that serelaxin has a neutral effect on diuretic response. These novel data from the RELAX-AHF trial were presented by lead author Professor Adriaan A. Voors at the Heart Failure Congress 2014, held 17-20 May in Athens, Greece. The Congress is the main annual meeting of the Heart Failure Association of the European Society of Cardiology. RELAX-AHF was a double blind, placebo-controlled trial ...

RELAX-AHF and PROTECT studies find targeting WHF may reduce readmissions and save lives

2014-05-17
Athens, 17 May 2014: Worsening symptoms and signs of heart failure (WHF) in patients admitted to a hospital is a common sign of treatment failure and can lead to long-term consequences for the patient, including longer length of hospitalization and a higher risk for readmission and death, according to a late-breaking study (RELAX-AHF, PROTECT) presented in Athens at the ESC's Heart Failure Congress 2014 Heart failure is the most common reason for admission to hospital in people over 65 years old and affects millions of people each year. Research has shown that the outcomes ...

Negative iron balance predicts acute heart failure survival

2014-05-17
Athens, 17 May 2014: Negative iron balance predicts survival in patients with acute heart failure, according to research presented for the first time today at the Heart Failure Congress 2014 in Athens, Greece. The Congress is the main annual meeting of the Heart Failure Association of the European Society of Cardiology. Professor Ewa Jankowska, first author of the study, said: "Patients with acute heart failure have a major collapse in homeostasis. Iron is a key micronutrient that is required for the maintenance of homeostasis. Iron is needed for cellular metabolism ...

Biomarker test for Peripartum Cardiomyopathy could help reduce death after giving birth

2014-05-17
Athens, 17 May 2014: Cardiologists have discovered biomarkers that can be used to develop a screening test to detect Peripartum Cardiomyopathy (PPCM), a life-threatening disorder that is the primary cause of mortality in pregnant women in developing countries. The results, which can lead to the immediate treatment of PPCM in new mothers and a significant reduction in mortality, were presented at Heart Failure 2014, which opened the World Congress on Acute Heart Failure in Athens the 17 to the 20 May. "For pregnant women there are two major causes of death: massive hemorrhage ...

Sleeping pills increase CV events in heart failure patients

2014-05-17
Athens, 17 May 2014: Sleeping pills increase the risk of cardiovascular events in heart failure patients by 8-fold, according to research from Japan. The study was presented today at the Heart Failure Congress 2014, held 17-20 May in Athens, Greece. The Congress is the main annual meeting of the Heart Failure Association of the European Society of Cardiology. Dr Masahiko Setoguchi said: "Sleeping problems are a frequent side effect of heart failure and it is common for patients to be prescribed sleeping pills when they are discharged from hospital. They also have other ...

The Lancet Infectious Diseases: New early warning system predicts dengue fever risk during the soccer World Cup in Brazil

2014-05-17
For the first time, scientists have developed an early warning system to predict the risk of dengue infections for the 553 microregions of Brazil during the football World Cup. The estimates, published in The Lancet Infectious Diseases, show that the chance of a dengue outbreak is enough of a possibility to warrant a high-alert warning in the three northeastern venues (Natal, Fortaleza, and Recife) but is likely to be generally low in all 12 host cities. Dengue is a viral infection that is transmitted between humans by Aedes aegypti mosquitoes. In some cases, it causes ...

Watching HIV bud from cells

Watching HIV bud from cells
2014-05-17
SALT LAKE CITY, May 16, 2014 – University of Utah researchers devised a way to watch newly forming AIDS virus particles emerging or "budding" from infected human cells without interfering with the process. The method shows a protein named ALIX gets involved during the final stages of virus replication, not earlier, as was believed previously. "We watch one cell at a time" and use a digital camera and special microscope to make movies and photos of the budding process, says virologist Saveez Saffarian, an assistant professor of physics and astronomy and senior author of ...

LAST 30 PRESS RELEASES:

Are lifetimes of big appliances really shrinking?

Pink skies

Monkeys are world’s best yodellers - new research

Key differences between visual- and memory-led Alzheimer’s discovered

% weight loss targets in obesity management – is this the wrong objective?

An app can change how you see yourself at work

NYC speed cameras take six months to change driver behavior, effects vary by neighborhood, new study reveals

New research shows that propaganda is on the rise in China

Even the richest Americans face shorter lifespans than their European counterparts, study finds

Novel genes linked to rare childhood diarrhea

New computer model reveals how Bronze Age Scandinavians could have crossed the sea

Novel point-of-care technology delivers accurate HIV results in minutes

Researchers reveal key brain differences to explain why Ritalin helps improve focus in some more than others

Study finds nearly five-fold increase in hospitalizations for common cause of stroke

Study reveals how alcohol abuse damages cognition

Medicinal cannabis is linked to long-term benefits in health-related quality of life

Microplastics detected in cat placentas and fetuses during early pregnancy

Ancient amphibians as big as alligators died in mass mortality event in Triassic Wyoming

Scientists uncover the first clear evidence of air sacs in the fossilized bones of alvarezsaurian dinosaurs: the "hollow bones" which help modern day birds to fly

Alcohol makes male flies sexy

TB patients globally often incur "catastrophic costs" of up to $11,329 USD, despite many countries offering free treatment, with predominant drivers of cost being hospitalization and loss of income

Study links teen girls’ screen time to sleep disruptions and depression

Scientists unveil starfish-inspired wearable tech for heart monitoring

Footprints reveal prehistoric Scottish lagoons were stomping grounds for giant Jurassic dinosaurs

AI effectively predicts dementia risk in American Indian/Alaska Native elders

First guideline on newborn screening for cystic fibrosis calls for changes in practice to improve outcomes

Existing international law can help secure peace and security in outer space, study shows

Pinning down the process of West Nile virus transmission

UTA-backed research tackles health challenges across ages

In pancreatic cancer, a race against time

[Press-News.org] Clinicians urged to consider spironolactone in HFPEF despite TOPCAT results
TOPCAT fails to meet primary endpoint but post-hoc analysis shows benefit in patients from Americas