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Imaging-Guided Cardioprotective Treatment in a Community Elderly Population of Stage B Heart Failure
Hong Yang1, Kazuaki Negishi1, Ying Wang1
1Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
Insights
Advanced echocardiography can detect stage B heart failure (SBHF), but treatment initiation is key. When patients adhered to recommended therapies, guided care significantly reduced cardiovascular events and heart failure.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Advanced echocardiography facilitates nonischemic stage B heart failure (SBHF) detection.
- Proven benefits of SBHF detection are contingent on effective treatment implementation.
Purpose of the Study:
- To assess the impact of advanced echocardiography-guided care on reducing new heart failure (HF) in the community.
- To evaluate the benefit of detecting stage B heart failure (SBHF) for new HF reduction.
Main Methods:
- 618 asymptomatic patients with HF risks were randomized to echocardiography-guided care or usual care.
- Advanced echocardiography assessed myocardial deformation and diastolic function.
- Treatment advice included ACE inhibitors and beta-blockers; PROBE trial design was used.
Main Results:
- Advanced echocardiography identified 219 patients with SBHF.
- No significant difference in HF incidence between groups due to low therapy initiation (43%) and target dose achievement (9%).
- Adherent patients in the imaging-guided arm showed a 77% lower hazard for the primary outcome (p=0.04).
Conclusions:
- SBHF detection via echocardiography correlated with increased HF and death incidence.
- Pharmacological intervention efficacy is limited by patient uptake; alternative strategies are needed.
- Adherence to imaging-guided therapy significantly improved outcomes, highlighting treatment compliance importance.
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).
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