Clinical trials update: IMPROVEMENT-HF, COPERNICUS, MUSTIC, ASPECT-II, APRICOT and HEART.
Important new studies relevant to the field of heart failure reported at the annual congress of the European Society of Cardiology (ESC), held in Amsterdam in August 2000, are reviewed. The IMPROVEMENT of Heart Failure survey investigated the knowledge and perceptions of over 1300 primary care physicians from 14 ESC member nations and the actual practice in over 11000 of their patients. Guidelines and clinical practice were compared. The survey suggested, in this large sample, that the quality of care was higher than previous smaller surveys have suggested but have also identified important deficiencies in knowledge and management that should be rectified. The COPERNICUS study demonstrated that carvedilol was remarkably well tolerated even in patients with very severe heart failure and that treatment was associated with a substantial reduction in mortality even among patients that would conventionally not be considered, by many, for beta-blocker therapy. The MUSTIC trial suggested that cardiac resynchronisation using biventricular pacing improved patients symptomatically whether or not the patient was in atrial fibrillation. Morbidity and mortality studies of cardiac resynchronisation are now underway. The ASPECT-II and APRICOT-II studies investigated the role of warfarin, aspirin and their combination for the long-term management of myocardial infarction. One interpretation of the data from these studies is that the combination of aspirin and warfarin is about as effective as warfarin alone but with a much higher incidence of side effects. Warfarin alone appeared superior to aspirin alone. In summary, the annual congress of the ESC provided important new information for clinical practice and, to date, was, by far, the most important cardiology congress in the world this year.
Witte
K
K
Academic Department of Cardiology, University of Hull, Castle Hill Hospital, Castle Road, Kingston upon Hull HU16 5JQ, UK. g.m.porter@medschool.hull.ac.uk
Thackray
S
S
Clark
A L
AL
Cooklin
M
M
Cleland
J G
JG
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000628:therapy; D000077261:Carvedilol; D002986:Clinical Trials as Topic; D003328:Coronary Thrombosis / Q000188:drug therapy; D018592:Cross-Over Studies; D004311:Double-Blind Method; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011412:Propanolamines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016037:Single-Blind Method; D015912:Thrombolytic Therapy
D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol