Carbohydrate Antigen-125-Guided Therapy in Acute Heart Failure: CHANCE-HF: A Randomized Study
Julio Núñez1, Pau Llàcer2, Vicente Bertomeu-González3
1Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
Insights
Carbohydrate Antigen-125 (CA125)-guided therapy significantly reduced 1-year death or acute heart failure readmissions compared to standard care. This CA125 strategy primarily lowered rehospitalization rates, demonstrating its effectiveness in managing heart failure patients.
Area of Science:
- Cardiology
- Biomarkers in Heart Failure
Background:
- Carbohydrate Antigen-125 (CA125) is a marker for fluid overload and inflammation in acute heart failure (AHF).
- Elevated CA125 levels and their changes over time after AHF hospitalization predict adverse outcomes.
- CA125 monitoring offers a potential strategy for guiding AHF treatment.
Purpose of the Study:
- To compare the prognostic impact of CA125-guided therapy versus standard of care (SOC) post-AHF hospitalization.
- To assess the efficacy of a CA125 strategy in reducing adverse events in AHF patients.
Main Methods:
- A prospective multicenter randomized trial involving 380 patients discharged for AHF with elevated CA125.
- Patients were assigned to either a CA125 strategy (target CA125 ≤35 U/ml) or SOC.
- The primary endpoint was the composite of all-cause death or AHF readmission at 1 year.
Main Results:
- The CA125 strategy group received more frequent visits, ambulatory IV diuretics, statins, and modifications to oral diuretics and aldosterone receptor blockers.
- The CA125 strategy significantly reduced the primary endpoint, both as a time-to-first event (p=0.017) and recurrent events (IRR=0.49, p=0.008).
- The reduction in the composite endpoint was driven by a significant decrease in rehospitalizations, with no significant impact on mortality.
Conclusions:
- CA125-guided therapy is superior to SOC in reducing the composite risk of death or AHF readmission at 1 year.
- The benefit of the CA125 strategy is primarily attributed to a significant reduction in heart failure rehospitalizations.
- This study supports the use of CA125 as a tool to guide therapy and improve outcomes in AHF survivors.
Objectives:
This study sought to evaluate the prognostic effect of carbohydrate antigen-125 (CA125)-guided therapy (CA125 strategy) versus standard of care (SOC) after a hospitalization for acute heart failure (AHF).
Background:
CA125 has emerged as a surrogate of fluid overload and inflammatory status in AHF. After an episode of AHF admission, elevated values of this marker at baseline as well as its longitudinal profile relate to adverse outcomes, making it a potential tool for treatment guiding.
Methods:
In a prospective multicenter randomized trial, 380 patients discharged for AHF and high CA125 were randomly assigned to the CA125 strategy (n = 187) or SOC (n = 193). The aim in the CA125 strategy was to reduce CA125 to ≤35 U/ml by up or down diuretic dose, enforcing the use of statins, and tightening patient monitoring. The primary endpoint was 1-year composite of death or AHF readmission. Treatment strategies were compared as a time to first event and longitudinally.
Results:
Patients allocated to the CA125 strategy were more frequently visited, and treated with ambulatory intravenous loop diuretics and statins. Likewise, doses of oral loop diuretics and aldosterone receptor blockers were more frequently modified. The CA125 strategy resulted in a significant reduction of the primary endpoint, whether evaluated as time to first event (66 events vs. 84 events; p = 0.017) or as recurrent events (85 events vs. 165 events; incidence rate ratio: 0.49; 95% confidence interval: 0.28 to 0.82; p = 0.008). The effect was driven by significantly reducing rehospitalizations but not mortality.
Conclusions:
The CA125 strategy was superior to the SOC in terms of reducing the risk of the composite of 1-year death or AHF readmission. This effect was mainly driven by significantly reducing the rate of rehospitalizations. (Carbohydrate Antigen-125-guided Therapy in Heart Failure [CHANCE-HF]; NCT02008110).
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