Yang, H and Negishi, K and Wang, Y and Nolan, M and Marwick, TH, Imaging-guided cardioprotective treatment in a community elderly population of stage B heart failure, JACC: Cardiovascular Imaging, 10, (3) pp. 217-226. ISSN 1936-878X (2017) [Refereed Article]
Copyright ©2017 Elsevier
Background: The detection of nonischemic SBHF has been facilitated by advanced echocardiographic imaging modalities. However, improved outcomes have not been proven as they are predicated on benefit of treatment.
Methods: Between September 13, 2013 and November 6, 2015, 618 asymptomatic community-based patients with HF risks (age 71 ± 5 years) were randomized to care guided by advanced echocardiography (myocardial deformation and detailed diastolic function) versus usual care. Evidence of SBHF led to advice to the patients and their primary physicians to initiate treatment with angiotensin-converting enzyme inhibition and beta-adrenoceptor blockade. The trial followed the PROBE (Prospective Randomized Open Blinded Endpoint) design. Participants were followed for 1 year for the primary composite endpoint of death from cardiovascular causes and new HF.
Results: Advanced echocardiography identified 219 as having SBHF and treatment was advised. Over a mean follow-up of 13 ± 6 months, 67 reached the primary endpoint. The incidence rate of HF was no different between the 2 arms (p = 0.47), likely because only 43% initiated therapy, and only 9% achieved target dose. Among subjects needing therapy on the basis of imaging and adherence to therapy, imaging-guided care showed a 77% lower hazard for the primary outcome (p = 0.04).
Conclusions: The detection of SBHF from strain and diastolic function evaluation was associated with a higher incidence of incidence HF and death. The efficacy of pharmacological intervention with angiotensin-converting enzyme inhibition and beta-adrenoceptor blockade is limited by its uptake, and alternative strategies should be considered. (Tasmanian Study of Echocardiographic Detection of Left Ventricular Dysfunction [TAS-ELF]; ACTRN12614000080628).
|Item Type:||Refereed Article|
|Keywords:||community detection, medication nonadherence, pharmacological intervention, randomized controlled trial, stage B heart failure|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Cardiovascular medicine and haematology|
|Research Field:||Cardiology (incl. cardiovascular diseases)|
|Objective Group:||Clinical health|
|Objective Field:||Clinical health not elsewhere classified|
|UTAS Author:||Yang, H (Ms Hilda Yang)|
|UTAS Author:||Negishi, K (Dr Kazuaki Negishi)|
|UTAS Author:||Wang, Y (Ms Ying Wang)|
|UTAS Author:||Nolan, M (Mr Mark Nolan)|
|UTAS Author:||Marwick, TH (Professor Tom Marwick)|
|Web of Science® Times Cited:||13|
|Deposited By:||Menzies Institute for Medical Research|
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