Clinical trials update from the American Heart Association meeting: Ω‐3 fatty acids and arrhythmia risk in patients with an implantable defibrillator, ACTIV in CHF, VALIANT, the Hanover autologous bone marrow transplantation study, SPORTIF V, ORBIT and PAD and DEFINITE

Abstract

The American Heart Association meeting reported the results of several clinical trials of particular interest to those who care for patients with heart failure. V-3 fatty acids were associated with a trend to increased recurrence of ventricular arrhythmias but not mortality in patients with an implantable debrillator. The ACTIV in CHF study provides more evidence of a therapeutic role for arginine vasopressin antagonists in the treatment of heart failure. The VALIANT study provides further evidence to suggest that a combination of angiotensin receptor antagonist and ACE inhibitor does not reduce mortality but may reduce morbidity in post-MI patients with heart failure or major LV systolic dysfunction. A study of autologous bone marrow cell transplantation into myocardial scar give gave encouraging results. SPORTIF V showed ximelagation to be as effective as warfarin but with improved safety. ORBIT and PAD showed public access defibrillators saved lives but questioned their cost effectiveness. DEFINITE supported a role for ICDs in patients with non-ischemic cardiomyopathy, although cost-effectiveness remains in doubt.

Clinical trials update and cumulative meta‐analyses from the American College of Cardiology: WATCH, SCD‐HeFT, DINAMIT, CASINO, INSPIRE, STRATUS‐US, RIO‐Lipids and cardiac resynchronisation therapy in heart failure

“…The direction and magnitude of benefit in SCD‐HeFT is consistent with the data from previous, unconfounded studies [9] (Fig. ).…”

Clinical trials update from the American Heart Association: REPAIR‐AMI, ASTAMI, JELIS, MEGA, REVIVE‐II, SURVIVE, and PROACTIVE

“…Previous studies of fish oil supplementation have shown conflicting results [3,4]. It is possible that the results of this study may have been influenced by the high level of fish consumption in the Japanese population compared to western countries.…”

Sudden Cardiac Death in Dilated Cardiomyopathies

“…85 ICD therapy reduced allcause mortality at 5 years by 23% in patients with predominantly NYHA class II heart failure and left ventricular systolic dysfunction. 86 There were 244 deaths (29%) in the placebo group, 240 (28%) in the amiodarone group, and 182 (22%, P < 0.007) in the ICD group. 87 Children with DCM constitute up to one-third of patients in pediatric series of ICD therapy, although half of these DCM children go on to device removal at transplantation.…”

“…SCD‐HeFT showed a significant reduction of total mortality in the ICD group, whereas amiodarone did not improve survival 85 . ICD therapy reduced all‐cause mortality at 5 years by 23% in patients with predominantly NYHA class II heart failure and left ventricular systolic dysfunction 86 . There were 244 deaths (29%) in the placebo group, 240 (28%) in the amiodarone group, and 182 (22%, P < 0.007) in the ICD group 87 …”