Hf Trials

Question 1

A-HEFT (2004)

Answer 1

Hydral 37.5+Isordil 20 TID

• CIII/IV Black Pts
• Improved mortality, Hosp, QOL

Question 2

Ascend-HF (2011)

Answer 2

Nesiritide

• ADHF, Acute HF, severe HF
• dyspnea better at 6h+24h, but not combined
• NO DIFF in 30day HF readmit
• NO DIFF in ARF or Death

Question 3

ATLAS

Answer 3

Low vs High Dose ACE

• NYHA II-IV, EF <30%
• decreased mortal TREND
• Lower Overall Death+Hosp
• Lower Admission

Question 4

CAPRICORN (2001)

Answer 4

COREG post-MI w/LV dysfunction
EF<40%
- Decreased all cause mortal of Admission for CV
- CV mortality, nonfatal MI

Question 5

CARRESS-HF (2012)

Answer 5

UF in DHF w/cardiorenal syndrom

• ADHF, increase Cr+Volume, comp to Diuresis
• Worse 2/2 inc Cr, no diff in weight, more AE (bleed, ARF)

Question 6

CASTLE-AF (2018)

Answer 6

Catheter Ablation for AF+HF

• RCT, failed Anti-arrth.
• Composite outcome Death/HF hosp better, death alone half
• Mostlcy CII, persistent AF (vs parox AF)

Question 7

CHARM (2003)

• Preserved
• Alternative
• Added

Answer 7

Candesartan
Preserved - No diff in death, less admisison
Alternative - Intolerant pts, less death+adm together+indiv
Added - Less Death+Adm together+indiv

Question 8

CHF-STAT (1995)

Answer 8

Amio in CHF+asymptomatic Vent Arrythmia

• Dilated LV+low ef
• No diff in survival, trend to lower mortal

Question 9

CIBIS (1994)
CIBIS II (1999)
CIBIS III (2005)

Answer 9

Bisoprolol+EF<40%
-Class III+IV on ace+diuretic
- No diff in sudden deaht, less hosp, improved sx
Bis EF<35%
- Mortality benefit
Bisoprolol first vs Enalapril First
- Noninferiority w/bisop first

Question 10

COMET (2003)

Answer 10

Coreg vs Metop Tartrate European

• C II-Iv, prev CV admit, EF <35% on ACE+diuretic
• Decreased mortal, similar admit

Question 11

CONSENSUS (1987)

Answer 11

Enalapril on CIV

• Mortal RRR 40%, 1yr 31%
• Decrease HF progression

Question 12

COPERNICUS (2002)

Answer 12

Coreg on EF<25%, CIII-IV

• Coreg 25 bid
• Reduced Death_Hosp for CV cause and HF cause

Question 13

CORONA (2007)

Answer 13

Crestor in rEF, CII-IV

- No reduced survival, poss reduced Hosp

Question 14

DIG trial (1997)

Answer 14

Dig on M&M of HFrEF

• No mortal diff
• Fewer Hosp

Question 15

EMPHASIS (2011)

Answer 15

Eplerenone HfrEF +MILD sx

- Dec death from CV or adm for HF, dec total mortal, dec hospitalization

Question 16

EPHESUS (2003)

Answer 16

Eplerenone POST-MI

• Dec comp death, hosp for HF, AMI, CVA, VT/VF
• Dec SCD
• Inc hyperkal (5.5 vs 4%)

Question 17

FAIR-HF (2009)

Answer 17

Ferric Carboxymaltose in HF+FE def

• CII or CII, EF<40%, Fe def+anemia
• Pt assessment better, improved NYHA class, 6MWT

Question 18

I-PRESERVE (2008)

Answer 18

Irbesartan in PRESERVED EF

• NYHA II-IV
• No diff in death or hosp rates

Question 19

MERIT-HF (1999)

Answer 19

Toprol HFrEF

• C II-IV, target 200qd
• RR 0.66, fewer Mortal, SCD, HF death

Question 20

NESIRITIDE (2000)

Answer 20

IV nes for DHF

- 6hr dec PCWP, reduced Dyspnea much more

Question 21

OPTIME-CHF (2002)

Answer 21

SHORT TERM Milrinone for ADHF

• IIIor IV, adm w/HF not req Inotropy
• 48h milrinone
• No sig diff in LOS, inc hypotension, inc atrial arryhtm, no diff in-hosp mortal or death/readm

Question 22

PARADIGM-HF (2014)

Answer 22

ENTRESTO VS ENALAPRIL

• CII-IV, EF <40%
• Dec death or Hosp for HF, less symptoms
• More HoTN+angioedema
• Inc BNP, nt-probnp
• excluded Hotn or HyperK pts

Question 23

PRAISE (1996)

Answer 23

Amlodipine in M&M for sev HF

• CIII or IV, EF <30%
• No change in death+hosp for cv
• poss benefit in nonischemics

Question 24

PROMISE (1991)

Answer 24

Oral milrinone in Mortal for CHF

• Pts on dig, diuretic, ACE
• Increase in all cause, CV mortal, worse for CIV
• More Hotn+syncope

Question 25

RALES (1999)

Answer 25

``` Spirinolactone on M&M for sHF - CIII or IV, EF <35%, ace/diuretic/dig - Dec death, dec prog HF+death from cardiac cause - Dec freq of Hosp Exclude Cr>2.5, K>5 ```

Question 26

SAVE (1992)

Answer 26

CAPTOPRIL M&M LV dysf post-MI - CI, 3-16d post MI - More death, severe HF, recurrent MI in placebo

Question 27

SENIORS (2005)

Answer 27

Nebivolol - Elderly+HF, >70% - All cause mortal+CV admit decreased - No diff in death alone

Question 28

SOLV-D (1991)

Answer 28

Enalapril in EF<35% and CII-IV - Bigger gp than CONSENSUS - pts on conventional therapy, dig/diuretic/nitrate - reduced mortality 16%, risk of death 2/2 hf, reduced hosp

Question 29

SOLV-T (D?) (1991) | SOLV-P (1992

Answer 29

Treatment: Enalapril in CHF+EF<35% - Inc survival, dec hosp, dec progression for HF Prevention: Enalapril Asymptom+low EF - Death Equal, less hosp for HF, less death+hosp for HF

Question 30

UNLOAD (2007)

Answer 30

UF vs IV diuretics ADHF | - more wt dec, dysp scores similar, 90d less readmit for HF

Question 31

US- Carvedilol (1996)

Answer 31

Carved on M&M of HF - EF<35% - Dec death, dec hosp, dec combo

Question 32

V-HEFT 1 (1986) V-HEFT 2 (1991) - Vasodilator study on Vets/MEN

Answer 32

1. Vasodilator on Mortal in CHF, chronic - No benefit for Prazosin - Benefit for Hydral/Isosorbite on death+EF 2. Enalapril vs Isordil - Enalapril better mortal, both inc ef, Isordil inc ET too

Question 33

Val-HEFT (2001)

Answer 33

Valsartan v Placebo - CII, III, IV - Combined dec mortal, HF adm, inotropy/vasodilator - Driven by Dec HF adm, also in NYHA, adverse effects if on ACE+BB

Question 34

VALIANT (2003)

Answer 34

Valsartan, Captopril, or both in MI+HF+rEF - .5-10d post MI - Non-signif diff in all 3 groups, ACE/ARB group had Most side effects

Question 35

WARCEF (2012)

Answer 35

Warfarin vs ASA in HF+Sinus Rhythm - Time to isch stroke, ICH, death - Coumadin INR 2-3.5 vs asa 325 - No difference. Less stroke in coumadin, more major hemorrhage

Question 36

Ambition trial

Answer 36

Ph

Question 37

Tread hf

Answer 37

Stopping hf meds | Worsen ef

Question 38

Us carvedilol

Answer 38

Coreg higher doses weight?

Question 39

DAPA-HF

Answer 39

Dapaglifozin in hfref - dapglif sglt2 in hf, only 45% w t2dm - early separation of all cause mortal and hf hosp - equal in dm and no dm!!

Question 40

Chf af

Answer 40

Amio for chf No diff in rate v rhythm control High rates of amio rather than ablation - thats why castle af different

Question 41

Ropa-Dope

Answer 41

Renal dose dopamine - no utility in hf - no improved renal function

Question 42

Caress- hf

Answer 42

acute decompensated HF and cardiorenal syndrome, ultrafiltration is associated with more adverse events, worsening renal function, and no change in weight when compared to medical therapy.

Question 43

Optime - hf

Answer 43

``` Iv milrinone decompensated hf without shock No sig diff milrinon v placebo No inhospital mortality diff More hypotension and atrial arrythmia Post hoc Icm worse nicm better ```

Question 44

Everest

Answer 44

Tolvaptan 15mg Diuresis of free water in hyponatremic patients Increase lfts outpatient after 30 days