Diuretic use and outcomes in patients with heart failure with reduced ejection fraction : Insights from the VICTORIA trial
© 2024 European Society of Cardiology..
AIMS: In VICTORIA, vericiguat compared with placebo reduced the risk of cardiovascular death (CVD) and heart failure hospitalization (HFH) in patients enrolled after a worsening heart failure (WHF) event. We examined clinical outcomes and efficacy of vericiguat as it relates to background use of loop diuretics in patients with WHF.
METHODS AND RESULTS: We calculated the total daily loop diuretic dose equivalent to furosemide dosing at randomization and categorized these as: no loop diuretic, 1-39, 41-80, 40, and >80 mg total daily dose (TDD). The primary composite outcome of CVD/HFH and its components were evaluated based on TDD loop diuretic and expressed as adjusted hazard ratios with 95% confidence intervals. Post-randomization rates of change in TDD were also examined. Of 4974 patients (98% of the trial) with diuretic dose information available at randomization, 540 (10.8%) were on no loop diuretic, 647 (13.0%) were on 1-39, 1633 (32.8%) were on 40, 1185 (23.8%) were on 41-80, and 969 (19.4%) were on >80 mg TDD. Patients with higher TDD had a higher rate of primary and secondary clinical outcomes. There were no significant interactions with TDD at randomization and efficacy of vericiguat versus placebo for any outcome (all pinteraction > 0.5). Post-randomization diuretic dose changes for vericiguat and placebo showed similar rates of up-titration (19.6 and 20.2/100 person-years), down-titration (16.8 and 18.1/100 person-years), and stopping diuretics (22.9 and 24.2/100 person-years).
CONCLUSIONS: Loop diuretic TDD at randomization was independently associated with worse outcomes in this high-risk population. The efficacy of vericiguat was consistent across the range of diuretic doses.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
European journal of heart failure - (2024) vom: 07. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ezekowitz, Justin [VerfasserIn] |
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| Links: |
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| Themen: |
Clinical trial |
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| Anmerkungen: |
Date Revised 07.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1002/ejhf.3179 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369406419 |
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| 100 | 1 | |a Ezekowitz, Justin |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Diuretic use and outcomes in patients with heart failure with reduced ejection fraction |b Insights from the VICTORIA trial |
| 264 | 1 | |c 2024 | |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2024 European Society of Cardiology. | ||
| 520 | |a AIMS: In VICTORIA, vericiguat compared with placebo reduced the risk of cardiovascular death (CVD) and heart failure hospitalization (HFH) in patients enrolled after a worsening heart failure (WHF) event. We examined clinical outcomes and efficacy of vericiguat as it relates to background use of loop diuretics in patients with WHF | ||
| 520 | |a METHODS AND RESULTS: We calculated the total daily loop diuretic dose equivalent to furosemide dosing at randomization and categorized these as: no loop diuretic, 1-39, 41-80, 40, and >80 mg total daily dose (TDD). The primary composite outcome of CVD/HFH and its components were evaluated based on TDD loop diuretic and expressed as adjusted hazard ratios with 95% confidence intervals. Post-randomization rates of change in TDD were also examined. Of 4974 patients (98% of the trial) with diuretic dose information available at randomization, 540 (10.8%) were on no loop diuretic, 647 (13.0%) were on 1-39, 1633 (32.8%) were on 40, 1185 (23.8%) were on 41-80, and 969 (19.4%) were on >80 mg TDD. Patients with higher TDD had a higher rate of primary and secondary clinical outcomes. There were no significant interactions with TDD at randomization and efficacy of vericiguat versus placebo for any outcome (all pinteraction > 0.5). Post-randomization diuretic dose changes for vericiguat and placebo showed similar rates of up-titration (19.6 and 20.2/100 person-years), down-titration (16.8 and 18.1/100 person-years), and stopping diuretics (22.9 and 24.2/100 person-years) | ||
| 520 | |a CONCLUSIONS: Loop diuretic TDD at randomization was independently associated with worse outcomes in this high-risk population. The efficacy of vericiguat was consistent across the range of diuretic doses | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Clinical trial | |
| 650 | 4 | |a Diuretics | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Medications | |
| 700 | 1 | |a Alemayehu, Wendimagegn |e verfasserin |4 aut | |
| 700 | 1 | |a Edelmann, Frank |e verfasserin |4 aut | |
| 700 | 1 | |a Ponikowski, Piotr |e verfasserin |4 aut | |
| 700 | 1 | |a Lam, Carolyn S P |e verfasserin |4 aut | |
| 700 | 1 | |a O'Connor, Christopher M |e verfasserin |4 aut | |
| 700 | 1 | |a Butler, Javed |e verfasserin |4 aut | |
| 700 | 1 | |a Corda, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a McMullan, Ciaran J |e verfasserin |4 aut | |
| 700 | 1 | |a Westerhout, Cynthia M |e verfasserin |4 aut | |
| 700 | 1 | |a Voors, Adriaan A |e verfasserin |4 aut | |
| 700 | 1 | |a Mentz, Robert J |e verfasserin |4 aut | |
| 700 | 1 | |a Armstrong, Paul W |e verfasserin |4 aut | |
| 700 | 0 | |a VICTORIA Study Group |e verfasserin |4 aut | |
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