Cardio Trial Files: Finerenone in HF, Interruption vs. Continuation of Beta-Blockers Post-MI, and FCM for HFpEF with ID
Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction
Solomon SD et al. NEJM (September 2024)
Bottom Line: This international, double-blind trial evaluated the efficacy and safety of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in patients with heart failure and mildly reduced or preserved ejection fraction. A total of 6001 patients were randomly assigned to receive either finerenone or placebo in addition to usual therapy. The primary outcome was a composite of total worsening heart failure events and death from cardiovascular causes over a median follow-up of 32 months. Finerenone resulted in a significantly lower rate of primary outcome events compared to placebo with 14.9 vs. 17.7 events per 100 patient-years (rate ratio, 0.84; 95% CI, 0.74 to 0.95; P = 0.007). The safety outcomes showed an increased risk of hyperkalemia and a reduced risk of hypokalemia with finerenone. In conclusion, finerenone showed efficacy in reducing the rate of primary outcome events in patients with heart failure and mildly reduced or preserved ejection fraction.
Beta-Blocker Interruption or Continuation after Myocardial Infarction
Silvain J et al. NEJM (August 2024)
Bottom Line: This multicenter, open label, randomized, noninferiority trial compared the safety and efficacy of interrupting long-term beta-blocker treatment in patients with a history of uncomplicated myocardial infarction. A total of 3698 patients with a history of myocardial infarction with no cardiac event within the past 6 months and a left ventricular ejection fraction of at least 40% were randomly assigned to either the interruption or continuation group. The primary outcome was a composite of death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for cardiovascular reasons at the longest follow-up. During a median follow-up of 3 years, the primary outcome occurred in 23.8% of patients in the interruption group and 21.1% of patients in the continuation group (HR=1.16, 95% CI, 1.01 to 1.33; P=0.44 for noninferiority). The results showed that beta-blocker interruption was not noninferior to continuation and there was no improvement in quality of life for patients in the interruption group. In conclusion, in patients with a history of myocardial infarction, interruption of long-term beta-blocker treatment was not found to be noninferior to continuation.
Ferric carboxymaltose and exercise capacity in heart failure with preserved ejection fraction and iron deficiency (FAIR-HFpEF)
von Haehling S et al. European Heart Journal (August 2024)
Bottom Line: This was a multicentre, randomized, double-blind trial that compared intravenous ferric carboxymaltose (FCM) to placebo (saline) in patients with symptomatic heart failure with preserved ejection fraction (HFpEF) and iron deficiency (ID). The trial was stopped early due to slow recruitment after 39 patients were included. The primary outcome was the change in 6-min walking test distance (6MWTD) at week 24. Results showed that FCM improved 6MWTD by on average 49 m within 24 weeks (95% CI, 5–93; P = 0.029) and was associated with fewer serious adverse events compared to placebo. However, the trial was not powered to determine effects on symptoms or quality of life. Further investigation with larger cohorts is needed to fully understand the potential benefits of intravenous iron in HFpEF with ID.
Cardio Trial Files Issue #CRD-2024-24
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