{"id":35389,"date":"2013-03-12T13:53:54","date_gmt":"2013-03-12T17:53:54","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=fellowship-training&p=35389"},"modified":"2013-03-12T14:15:56","modified_gmt":"2013-03-12T18:15:56","slug":"more-negative-heart-failure-trials-blogging-from-acc-13","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/03\/12\/more-negative-heart-failure-trials-blogging-from-acc-13\/","title":{"rendered":"More Negative Heart Failure Trials: Blogging from ACC.13"},"content":{"rendered":"

Several Cardiology Fellows who are attending ACC.13 in San Francisco this week are blogging for CardioExchange. The Fellows include\u00a0Tariq Ahmad<\/strong><\/a>,\u00a0<\/em>Megan Coylewright<\/strong><\/a>,\u00a0<\/em>Jeremiah Depta<\/a>,\u00a0Kumar Dharmarajan<\/a>,\u00a0<\/strong><\/em><\/strong>\u00a0Payal Kohli<\/a><\/strong><\/em>,\u00a0and \u00a0Sandeep Mangalmurti<\/a><\/strong><\/em>.\u00a0View the previous post\u00a0here<\/a>\u00a0and the next one here<\/a>.<\/em><\/p>\n

<\/em>Some important \u201clate breakers\u201d\u00a0were\u00a0presented today, the 3rd and last day of ACC.13. I was particularly looking forward to hearing the results of the RELAX trial<\/a>. Would sildenafil be useful for the treatment of diastolic heart failure? For a disease that appears to have no treatment, the results of this exciting Heart Failure Network study were highly anticipated by patients and physicians alike.<\/p>\n

The results of ASTRONAUT<\/a> were also presented. This looked at the use of aliskiren (direct renin inhibitor) in systolic heart failure.<\/p>\n

However, as with most trials in heart failure, the results were negative.<\/p>\n

I wonder why we continue to have such terrible luck with therapeutics in heart failure. Perhaps the disease is far too complex for drugs based on single targets to be successful. Or maybe we are viewing the disease process incorrectly and need a paradigm shift in how we describe heart failure.<\/p>\n

Is there even such a thing as diastolic and systolic heart failure? Until the 18th century, diseases were described in terms of evil humors, and patients treated accordingly (by bleeding or purging). As might be expected, the treatments were ineffective. We may continue to be victims of inaccurate classifications.<\/p>\n

On a more positive note, I found the results of the STOP-HF<\/a> trial to be quite intriguing. This study looked at the benefit of natriuretic guided screening and treatment in patients with stage A heart failure. The investigators found very significant decreases in heart failure and cardiovascular events.<\/p>\n

I am the fellow on the GUIDE-IT trial that just began enrollment. My mentor at DCRI, Mike Felker, is the PI on this trial. We are looking at the effects of natriuretic peptide guided treatment in patients with advanced heart failure.<\/p>\n

As we understand more about the molecular biology of heart failure, we may\u00a0have more tools like the natriuretic peptides that help us define and treat the disease more effectively.<\/p>\n

And therapeutics aimed at more accurate definitions of heart failure might result in more positive trial results.<\/p>\n

For\u00a0<\/em>more of our ACC.13 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our\u00a0Coverage Headquarters<\/a>.<\/em>
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Might more accurate definitions of heart failure result in more positive trial results?<\/p>\n","protected":false},"author":406,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14],"tags":[287,951],"class_list":["post-35389","post","type-post","status-publish","format-standard","hentry","category-heart-failure","tag-heart-failure-2","tag-natriuretic-peptide"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/35389","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/406"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=35389"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/35389\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=35389"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=35389"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=35389"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}