Tag: Outcomes

Sacubitril/Valsartan improves quality of life in patients with HFrEF

Contributor: Nicholas Hawkes

 

Quality not quantity. Why not both? It is established that sacubitril/valsartan is superior to enalapril (or dose-equivalent ACE-I) when it comes to mortality and morbidity in HFrEF. But what about quality of life (QoL)? Patients enrolled in PARADIGM-HF had increased quality of life when randomized to sacubitril/valsartan.

In the 8399 HFrEF patients of the PARADIGM-HF study, 7623 patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) at multiple time points.  This well-validated tool measures health related quality of life. The KCCQ assessment reflected improved in quality of life for patients on sacubitril/valsartan compared to dose-equivalent ACE-I. Worth mentioning, the first KCCQ was administered 5-10 weeks after randomization, following the “run-in” period after which patients were randomized in a blinded fashion to either enalapril BID or sacubitril/valsartan.

Changes in the clinical summary score (KCCQ-CS) and overall score (KCCQ-OS) were assessed between randomization and 8 months. In a multivariable model, randomization to sacubitril/valsartan remained an independent predictor of QoL improvement.

QoL scores were high in this study. The higher scores may reflect the unique study schedule of the PARADIGM-HF in that the first KCCQ survey was given following the run-in phase. Further, it is known that health related QoL perceptions can improve in the setting of a clinical trial.

In a heartbeat… 

HFrEF patients treated with Sacubitril/Valsartan reported higher QoL score compared to patients randomized to enalapril.

Study Link

Concentric left ventricular hypertrophy rarely leads to dilated cardiomyopathy

Contributor: Jennifer Huang

 

Does concentric left ventricular hypertrophy (LVH) progress to dilated cardiomyopathy (DCM)? It may not be as common as we previously thought and the transition may occur over decades.

1,386 participants of the Dallas Heart Study without baseline LV dilation were included. Ten percent of the participants had baseline LVH (7.2 g/mL0.67  for men and 5.8 g/mL0.67 for women). The study population had a mean age of 44 years, 57% women and 43% black patients. Of note, patients that developed cardiovascular disease during the study period (MI, CABG, PCI, stroke or HF) were not included in the final cohort of 1282. Baseline and follow up cardiac magnetic resonance imaging was performed a median of 7 years after baseline imaging.

An increase in LVEDV was significantly (p<0.01) more common among patients with baseline LVH. However, the change in LVEDV was small (1ml in those with LVH and -2ml in those without) over the 7 year period. Overall, the progression to DCM was 3% in those with LVH and 2% in those without LVH.

In a heartbeat…

LVH hearts tend to slightly increase LVEDV over time, but progression to DCM remains a rare phenomenon, at least in the Dallas Heart Study cohort.

Study Link

Heart failure begets kidney disease

 

Contributor: Jennifer Huang

 

Data from over 3 million US Veterans explored connections between HF and kidney disease, common co-morbid players. The data showed that having HF increases the risk of developing kidney disease and accelerates the process.

Hemodynamic changes (low cardiac output and increased renal venous pressure), neurohormonal changes (activation of the sympathetic nervous and renin angiotensin systems), increased oxidative stress, and inflammatory activation are likely to blame. Additionally, elevated renal G-Protein Coupled Receptor – G protein – was associated with renal tissue damage, fibrosis, and inflammation.

Everything should be taken with a grain (<2 gm) of salt. The limitations of this study are its observational nature, more than 90% male participants, and use of ICD-9 codes to define HF with no differentiation between HFpEF and HFrEF.

In a heartbeat…

Having HF is associated with future development of kidney disease through various mechanisms. As such, patients with known HF (HFpEF or HFrEF) may benefit from aggressive renoprotective measures.

Study Link