This article provides information and a commentary on landmark trials presented at the American Heart Association meeting held in November 2004, relevant to the pathophysiology, prevention, and treatment of
heart failure. An open trial of the ACORN Cardiac Support Device (CSD) showed encouraging preliminary results in patients with severe
heart failure. The PEACE (Prevention of Events with
Angiotensin-Converting Enzyme inhibition) study supports data from previous studies showing that
ACE inhibitors reduce vascular events in patients at increased risk. The CREATE (clinical trial of metabolic modulation in acute MI treatment evaluation) study of patients with acute
myocardial infarction (MI) showed no mortality benefit of a
glucose/
insulin/
potassium regimen, but treatment with
reviparin reduced the incidence of death, MI, or
stroke.
Azimilide was not associated with a significant reduction in shocks, but reduced the shocks or episodes of markedly symptomatic
ventricular tachycardia terminated by pacing in the SHIELD (
Shock Inhibition Evaluation with
Azimilide) study. The addition of
isosorbide dinitrate plus
hydralazine to standard
therapy improved survival in black
heart failure patients in the A-HeFT (African-American
Heart Failure Trial) study. In an investigation of hypertensive patients with diabetes,
carvedilol had fewer adverse effects on diabetic control than
metoprolol. A meta-analysis of high-dose
vitamin E supplementation suggested an association with increased mortality. The ESCAPE (Evaluation Study of CHF and Pulmonary Artery Catheterisation Effectiveness) study showed no benefit of pulmonary artery catheterisation over clinical management in patients with severe
heart failure. Routine prophylactic coronary revascularisation for stable
coronary disease prior to major
vascular surgery showed no benefit in the CARP (Coronary Artery Revascularization Prophylaxis) study. Analysis of data from SCD-HeFT supports the cost-effectiveness of ICDs in
heart failure, although overall cost implications may be prohibitive.