HOT LINE
Hot
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Barcelona, 3 September 2006
The first hot line session focused on a variety of topics, ranging from the effect ofACE inhibitors in elderly patients with diastolic heart failure, a nurseled multidisciplinary preventive cardiology programme for patients with coronary disease, the effect of immune modulation therapy in chronic heart failure, a new approach to telemonitoring of patients with chronic heart failure to a meta-analysis of randomised trials on the safety offirst-generation drug-eluting stents. This session was chaired by M. Komajda (Paris, France) and R. Ferrari (Ferrara, Italy). The first presentation was byj G.F. Cleland (Kingston upon Hull, UK) who reviewed the PEP-CHF (The Perindopril in Elderly People with Chronic Heart Failure) study. The aim of this study was to determine whether perindopril therapy in elderly patients with heart failure (HF) and preserved systolic left ventricular function would reduce all-cause death or HF hospitalisation. This multicentre, double-blind randomised study compared 4 mg of perindopril (n=424) with placebo (n=426). Patients were aged on average 75 years, 56% were female, 79% had documented hypertension, 20% diabetes, the mean LVEF was 65%, and 75% were in NYHA class I/II. Perindopril or placebo was discontinued in almost 40% ofthe patients by 18 months, and replaced by open-label ACE inhibitors in both groups. The primary composite endpoint of all-cause death or hospitalisation for HF at one year was in favour of the perindopril group (10.8 vs. 15.3%, hazard ratio (HR) 0.69, 95% CI: 0.47-1.01). This was entirely driven by the lower number of HF hospitalisations in the perindopril group, (8 vs. 12.4%), respectively. At a mean follow-up of26 months, there was no difference in the primary endpoint between the treatment groups, (HR 0.92, 95% CI: 0.70-1.21). In conclusion, in elderly patients with diastolic HF, perindopril showed a slight benefit in terms ofreduction ofall-cause death or HF hospitalisation at one year. This benefit was no longer present at later follow-up. The power of the study was reduced because of the slow recruitment of patients (eventually 850 instead of 1000 patients were H.M. Nathoe Department of Cardiology, University Medical Centre Utrecht and Diakonessenhuis Utrecht, the Netherlands E-mail: [email protected]
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included), low occurrence of events and cross-over of patients allocated to placebo to open label ACE inhibitors at later follow-up. Although the PEP-CHF study is not conclusive, there might be a benefit from perindopril in diastolic dysfunction. The next contribution to this session was from D.A. Wood (London, UK), who discussed EUROACTION, a nurse-led multidisciplinary preventive cardiology programme for coronary patients, high-risk individuals and their families. The objective was to find out whether a nurse-led intervention would improve lifestyle and risk factors in patients with coronary disease, high-risk individuals and their families. This was a multicentre randomised study. Previously hospitalised patients with coronary disease and high-risk individuals from general practice were randomised to the EUROACTION intervention programme (n=2778 patients and 1632 partners) or usual care (n=2613 patients and 1634 partners). In the intervention group, a nurse-led intervention team sought to improve lifestyle (diet, physical activity, central obesity, blood pressure, cholesterol, and glucose), cessation of smoking and adherence to cardioprotective medication. As compared with usual care in the coronary cohort, cessation of smoking was higher in the intervention group (58 vs. 47%, p=0.06). Adherence to recommended fruit and vegetable intake guidelines was higher in the intervention group versus usual care (coronary cohort: 72% vs. 35%, p
Hot
line
I
Barcelona, 3 September 2006
The first hot line session focused on a variety of topics, ranging from the effect ofACE inhibitors in elderly patients with diastolic heart failure, a nurseled multidisciplinary preventive cardiology programme for patients with coronary disease, the effect of immune modulation therapy in chronic heart failure, a new approach to telemonitoring of patients with chronic heart failure to a meta-analysis of randomised trials on the safety offirst-generation drug-eluting stents. This session was chaired by M. Komajda (Paris, France) and R. Ferrari (Ferrara, Italy). The first presentation was byj G.F. Cleland (Kingston upon Hull, UK) who reviewed the PEP-CHF (The Perindopril in Elderly People with Chronic Heart Failure) study. The aim of this study was to determine whether perindopril therapy in elderly patients with heart failure (HF) and preserved systolic left ventricular function would reduce all-cause death or HF hospitalisation. This multicentre, double-blind randomised study compared 4 mg of perindopril (n=424) with placebo (n=426). Patients were aged on average 75 years, 56% were female, 79% had documented hypertension, 20% diabetes, the mean LVEF was 65%, and 75% were in NYHA class I/II. Perindopril or placebo was discontinued in almost 40% ofthe patients by 18 months, and replaced by open-label ACE inhibitors in both groups. The primary composite endpoint of all-cause death or hospitalisation for HF at one year was in favour of the perindopril group (10.8 vs. 15.3%, hazard ratio (HR) 0.69, 95% CI: 0.47-1.01). This was entirely driven by the lower number of HF hospitalisations in the perindopril group, (8 vs. 12.4%), respectively. At a mean follow-up of26 months, there was no difference in the primary endpoint between the treatment groups, (HR 0.92, 95% CI: 0.70-1.21). In conclusion, in elderly patients with diastolic HF, perindopril showed a slight benefit in terms ofreduction ofall-cause death or HF hospitalisation at one year. This benefit was no longer present at later follow-up. The power of the study was reduced because of the slow recruitment of patients (eventually 850 instead of 1000 patients were H.M. Nathoe Department of Cardiology, University Medical Centre Utrecht and Diakonessenhuis Utrecht, the Netherlands E-mail: [email protected]
4
included), low occurrence of events and cross-over of patients allocated to placebo to open label ACE inhibitors at later follow-up. Although the PEP-CHF study is not conclusive, there might be a benefit from perindopril in diastolic dysfunction. The next contribution to this session was from D.A. Wood (London, UK), who discussed EUROACTION, a nurse-led multidisciplinary preventive cardiology programme for coronary patients, high-risk individuals and their families. The objective was to find out whether a nurse-led intervention would improve lifestyle and risk factors in patients with coronary disease, high-risk individuals and their families. This was a multicentre randomised study. Previously hospitalised patients with coronary disease and high-risk individuals from general practice were randomised to the EUROACTION intervention programme (n=2778 patients and 1632 partners) or usual care (n=2613 patients and 1634 partners). In the intervention group, a nurse-led intervention team sought to improve lifestyle (diet, physical activity, central obesity, blood pressure, cholesterol, and glucose), cessation of smoking and adherence to cardioprotective medication. As compared with usual care in the coronary cohort, cessation of smoking was higher in the intervention group (58 vs. 47%, p=0.06). Adherence to recommended fruit and vegetable intake guidelines was higher in the intervention group versus usual care (coronary cohort: 72% vs. 35%, p
