Once COVID-19 subsided in 2022, most of the healthcare scene began to resemble more normality, and cardiology sees the research on typical cardiovascular practice areas and areas with therapeutic advancements. This article summarises a few of the most significant practice-changing trials. 

EMPULSE study - Empagliflozin in patients hospitalised for acute heart failure 

1. The EMPULSE study demonstrated that empagliflozin helped individuals with acute decompensated heart failure reduce adverse events. At 90 days, empagliflozin vs placebo was linked with a substantial clinical benefit in individuals with acute decompensated heart failure.
2. There was no indication of a treatment interaction based on either the participants' ejection fraction or diabetes status in this study, which included patients regardless of these factors.
3. Empagliflozin's benefit was unrelated to baseline symptomatic impairment. Moreover, empagliflozin vs placebo was linked to a decrease in fatalities, an increase in quality of life, and a higher loss of body weight.
4. Empagliflozin's safety was not an issue. In comparison to the placebo, empagliflozin was also linked to enhanced weight loss (decongestion).

DAPA-HF study - Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction

1. The DAPA-HF study demonstrated that dapagliflozin prevented cardiovascular mortality and heart failure events among heart failure patients better than placebo.
2. Dapagliflozin was helpful for people with symptomatic HFrEF. When compared to a placebo, dapagliflozin was linked to a reduction in heart failure and cardiovascular mortality.
3. Dapagliflozin vs placebo was linked to both an improvement in symptoms and a decrease in recurrent heart failure episodes. Compared to placebo, dapagliflozin was linked to a decrease in ventricular arrhythmias.
4. Benefits were the same regardless of age, risk, baseline diuretic usage, baseline sacubitril/valsartan use, diabetics vs non-diabetics, baseline health status range, and baseline pharmaceutical use (for instance, baseline sacubitril/valsartan and MRAs). Negative safety occurrences were not apparent.
5. Low levels of sacubitril/valsartan were first used. Dapagliflozin often caused eGFR to decline, however, this was actually correlated with improved clinical results. Dapagliflozin is a crucial drug for the treatment of HFrEF sufferers.

VALOR-HCM - Mavacamten in Adults With Symptomatic Obstructive HCM Who Are Eligible for Septal Reduction Therapy

Mavacamten relieved symptoms and substantially decreased eligibility for septal reduction treatment (SRT) among symptomatic patients with obstructive HCM who were contemplating SRT and receiving maximally tolerated medicinal therapy.

Mavacamten is a specific cardiac myosin inhibitor. It lowers the number of myosin-actin cross-bridges and the HCM-associated excessive contractility. Mavacamten was superior to placebo in improving patient-centred outcomes in the EXPLORER-HCM study. So, the present results are complementary to that study. Long-term information is required on the safety and effectiveness of mavacamten, as well as any effects on clinical outcomes.

TRANSFORM-HF - Torsemide Comparison With Furosemide for Management of Heart Failure

1. In the treatment of patients with decompensated heart failure, the TRANSFORM-HF study was unable to demonstrate that torsemide was better than furosemide in terms of increasing survival.
2. The post-discharge care of patients with decompensated heart failure with torsemide was not better than furosemide. Mortality from all causes was comparable across treatment groups.
3. Furosemide or torsemide are both suitable diuretic alternatives for heart failure patients.

ADVOR - Acetazolamide in Decompensated Heart Failure With Volume Overload

1. In the ADVOR study, the addition of acetazolamide to loop diuretic treatment increased the rate of effective early decongestion among patients with acute decompensated heart failure compared to placebo.
2. In patients with acute decompensated heart failure, therapy with intravenous acetazolamide with intravenous loop diuretics resulted in a substantially higher rate of effective decongestion within three days after randomization compared to placebo, regardless of baseline LVEF.
3. The carbonic anhydrase inhibitor acetazolamide decreases sodium and bicarbonate ion reabsorption in the proximal renal tubule. Those who took acetazolamide had a shorter duration of stay, but there was no statistically significant difference in the incidence of adverse events between the two trial groups.
4. The research was conducted just in Belgium, which may restrict its applicability to other racial/ethnic groups, and concurrent SGLT2i usage was not permitted. It is similarly modest in size. Due to the fact that SGLT2i also functions at the level of the renal proximal tubule, the effectiveness of acetazolamide in combination with SGLT2i is uncertain and will need more investigation.
5. In patients with acute decompensated heart failure, however, obtaining effective decongestion is a prevalent obstacle. Post-discharge unfavourable outcomes are more probable for patients with persistent congestion. Strong evidence supports the use of IV acetazolamide to accomplish decongestion in patients with decompensated heart failure, according to the present investigation.

DIAMOND - Patiromer for the management of hyperkalemia in subjects receiving RAASi for HFrEF

The DIAMOND study demonstrated that patiromer is efficient in maintaining lower blood potassium levels in patients with decreased ejection fraction heart failure (HFrEF). For HFrEF patients with a history of hyperkalemia, patiromer was advantageous.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.