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Imaging-guided cardioprotective treatment in a community elderly population of stage B heart failure

Citation

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 Statement

Copyright 2017 Elsevier

DOI: doi:10.1016/j.jcmg.2016.11.015

Abstract

Objectives: The purpose of the study was to evaluate the benefit of care guided by the detection of stage B heart failure (SBHF) using advanced echocardiography for the reduction of new HF in the community.

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 Details

Item Type:Refereed Article
Keywords:community detection, medication nonadherence, pharmacological intervention, randomized controlled trial, stage B heart failure
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Yang, H (Ms Hong Yang)
Author:Negishi, K (Dr Kazuaki Negishi)
Author:Wang, Y (Ms Ying Wang)
Author:Nolan, M (Mr Mark Nolan)
Author:Marwick, TH (Professor Tom Marwick)
ID Code:117605
Year Published:2017
Web of Science® Times Cited:3
Deposited By:Menzies Institute for Medical Research
Deposited On:2017-06-20
Last Modified:2018-06-05
Downloads:0

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