Heart Failure Group at SCMH @ESC Congress 2022
The ESC Congress 2022 was busy for the HF team with multiple presentations and publications. In total 16 papers led or involving HF team members were simultaneously published at the ESC (see figure) along with 17 presentations and invited lectures being given by group members (see full list at the end).
On the 26th August Professor John McMurray presented the results of the PERSPECTIVE trial which examined the effect of sacubitril/valsartan on cognitive function and beta-amyloid deposition in the brain. There had been a theoretical worry with the neprilysin inhibitor sacubitril, that it may increase the risk of Alzheimer’s type dementia. However, in PERSPECTIVE there was no difference in cognitive function in patients randomised to sacubitril/valsartan compared to valsartan alone and there was less beta-amyloid deposition in the brain in the patients randomised to sacubitril/valsartan removing any concern doctors may have had about long term treatment with the drug recommended by guidelines for the treatment of heart failure
At the hotline session on the 27th August a number of analyses involving the HF team were presented. The first was a presentation of the results of the DELIVER trial which was Co-chaired by Professor John McMurray with Professor Pardeep Jhund as a co-author (and co-chair of the endpoint committee). The results showed that dapagliflozin reduced the the primary composite endpoint of cardiovascular death or worsening heart failure by 18% in patients with mildly reduced or preserved ejection fraction, offering a new option for the treatment of these patients who do not have any effective therapies recommended in the guidelines. The full results of the trial were published simultaneously in the New England Journal of Medicine.
In the same session Professor Pardeep Jhund (University of Glasgow co-authors Drs Kondo, Butt, Docherty, Prof McMurray) presented a pooled analysis that investigated the effects of dapagliflozin across the full spectrum of ejection fraction. This was a prespecified patient-level meta-analysis of data from DELIVER in patients with LVEF >40% and data from the already published DAPA-HF trial in patients with reduced LVEF (≤40%). He reported a 14% reduction in cardiovascular death as well as reductions in all-cause death (10%), total hospital admissions for HF (29%) and major adverse cardiovascular events (CV death, myocardial infarction or stroke; 10%). There was no evidence that the effect of dapagliflozin differed by LVEF for any of the outcomes. The work was simultaneously published in Nature Medicine.
In the final presentation of the session, work led by Dr Kieran Docherty (University of Glasgow co-authors Profs Jhund and McMurray) was also presented. In a meta-analysis of two large randomised trials of SGLT2i in patients with heart failure with mildly reduced or preserved ejection fraction, the primary composite outcome of cardiovascular death or hospitalisation for heart failure was reduced by 20%, confirming the benefit of this class of drugs in this population. The analysis went on to also confirm a 23% reduction in the risk of this outcome when 5 trials from patients with heart failure were pooled into a meta-analysis. The work was published simultanously online at the Lancet.
The final hotline session to feature work by a HF team member took place on the 27th August. The REVIVED-BCIS2 trial, with Professor Mark Petrie as a steering committee member, was presented. This trial tested whether PCI was superior to medical therapy for patients with ischaemic heart failure. The trial showed that there was no difference in a range of outcomes for the patients randomised to PCI, PCI did not improve ejection fraction or health related quality of life scores at 12 months. The full results were published online simultaneously at the New England Journal of Medicine.
First published: 1 September 2022