News

Real-World HF Findings at Odds With Clinical Trials

View on the News

Which Results Should Clinicians Believe?

If clinicians consider the totality of the evidence from these two observational studies and the randomized clinical trials that they appear to contradict, we can arrive at two sound conclusions: First, it is reasonable to use RAS antagonists to control hypertension in HF with preserved ejection fraction; second, aldosterone antagonists are effective but should be used carefully and selectively in patients who have HF with reduced ejection fraction, said Dr. James C. Fang.

"Although clinical trials should remain the gold standard for testing hypotheses, observational studies bridge the gap from the scientific rigor of clinical trials to real-world experience," he said.

Dr. Fang is at University Hospitals Case Medical Center, Cleveland. He had no financial conflicts of interest. These remarks were taken from his editorial accompanying the reports by Dr. Hernandez and Dr. Lund (JAMA 2012;308:2144-6).


 

FROM JAMA

They performed one further consistency analysis to affirm their findings, and found a dose-response relationship: the greater the use of RAS antagonists, the greater the reduction in mortality.

Taken together, these findings suggest that RAS antagonists may be beneficial for patients who have HF with preserved ejection fraction, "but this should be confirmed in an appropriately powered randomized trial," they added.

Dr. Hernandez’s study was funded by the Agency for Healthcare Research and Quality; he reported ties to Amylin Pharmaceutical, Johnson & Johnson, AstraZeneca, Corthera, and Sanofi-Aventis, and his associates reported ties to numerous industry sources.

Dr. Lund’s study was funded by the Swedish National Board of Health and Welfare, the Swedish Association of Local Authorities and Regions, the Swedish Society of Cardiology, the Swedish Heart-Lung Foundation, and Astra-Zeneca; he reported ties to AstraZeneca, Thoratec, and HeartWare.

Pages

Recommended Reading

AHF Treatment, But Not Mortality, Differs Between Sexes
MDedge Internal Medicine
Underuse of Aldosterone Antagonists Contributes to Heart Failure Deaths
MDedge Internal Medicine
Spironolactone Shows Efficacy in Diastolic Heart Failure
MDedge Internal Medicine
Smartphones Poised to Revolutionize Heart Failure Monitoring
MDedge Internal Medicine
Stem Cell Treatment Post PCI Didn't Improve Outcomes
MDedge Internal Medicine
Left-Atrial MAZE Ablation Compromises Atrial Function
MDedge Internal Medicine
RELAX-AHF: Serelaxin Promising for Acute Heart Failure
MDedge Internal Medicine
Calcium Channel Blockers Aid Rate Control in AF
MDedge Internal Medicine
New Door Opens for Cardiac Resynchronization Therapy
MDedge Internal Medicine
In Type 1 Diabetes, Cardiac Measures Improved After Pancreas Transplant
MDedge Internal Medicine