title: Carbohydrate Antigen-125-Guided Therapy in Acute Heart Failure: CHANCE-HF: A Randomized Study.
abstract: This study sought to evaluate the prognostic effect of carbohydrate antigen-125 (CA125)-guided therapy (CA125 strategy) versus standard of care (SOC) after a hospitalization for acute heart failure (AHF).
  
  
  
  CA125 has emerged as a surrogate of fluid overload and inflammatory status in AHF. After an episode of AHF admission, elevated values of this marker at baseline as well as its longitudinal profile relate to adverse outcomes, making it a potential tool for treatment guiding.
  
  
  
  In a prospective multicenter randomized trial, 380 patients discharged for AHF and high CA125 were randomly assigned to the CA125 strategy (n = 187) or SOC (n = 193). The aim in the CA125 strategy was to reduce CA125 to ≤35 U/ml by up or down diuretic dose, enforcing the use of statins, and tightening patient monitoring. The primary endpoint was 1-year composite of death or AHF readmission. Treatment strategies were compared as a time to first event and longitudinally.
  
  
  
  Patients allocated to the CA125 strategy were more frequently visited, and treated with ambulatory intravenous loop diuretics and statins. Likewise, doses of oral loop diuretics and aldosterone receptor blockers were more frequently modified. The CA125 strategy resulted in a significant reduction of the primary endpoint, whether evaluated as time to first event (66 events vs. 84 events; p = 0.017) or as recurrent events (85 events vs. 165 events; incidence rate ratio: 0.49; 95% confidence interval: 0.28 to 0.82; p = 0.008). The effect was driven by significantly reducing rehospitalizations but not mortality.
  
  
  
  The CA125 strategy was superior to the SOC in terms of reducing the risk of the composite of 1-year death or AHF readmission. This effect was mainly driven by significantly reducing the rate of rehospitalizations. (Carbohydrate Antigen-125-guided Therapy in Heart Failure [CHANCE-HF]; NCT02008110).
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain. Electronic address: yulnunez@gmail.com.
authors: Julio
authors: J
authors: Núñez
authors: Servicio de Medicina Interna, Hospital de Manises, Valencia, Spain.
authors: Pau
authors: P
authors: Llàcer
authors: Servicio de Cardiología, Hospital de San Juan, Alicante, Spain.
authors: Vicente
authors: V
authors: Bertomeu-González
authors: Servicio de Medicina Interna, Hospital de la Plana, Castellón, Spain.
authors: Maria José
authors: MJ
authors: Bosch
authors: Servicio de Cardiología, Hospital de Manises, Valencia, Spain.
authors: Pilar
authors: P
authors: Merlos
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Sergio
authors: S
authors: García-Blas
authors: Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Vicente
authors: V
authors: Montagud
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Vicent
authors: V
authors: Bodí
authors: Servicio de Cardiología, Hospital de San Juan, Alicante, Spain.
authors: Vicente
authors: V
authors: Bertomeu-Martínez
authors: Servicio de Cardiología, Hospital de Manises, Valencia, Spain.
authors: Valle
authors: V
authors: Pedrosa
authors: Servicio de Medicina Interna, Hospital de Manises, Valencia, Spain.
authors: Andrea
authors: A
authors: Mendizábal
authors: Servicio de Cardiología, Hospital de San Juan, Alicante, Spain.
authors: Alberto
authors: A
authors: Cordero
authors: Servicio de Medicina Interna, Hospital de la Plana, Castellón, Spain.
authors: Jorge
authors: J
authors: Gallego
authors: Servicio de Medicina Interna, Hospital de la Plana, Castellón, Spain.
authors: Patricia
authors: P
authors: Palau
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Gema
authors: G
authors: Miñana
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Enrique
authors: E
authors: Santas
authors: Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Salvador
authors: S
authors: Morell
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Angel
authors: A
authors: Llàcer
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Francisco J
authors: FJ
authors: Chorro
authors: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors: Juan
authors: J
authors: Sanchis
authors: Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Lorenzo
authors: L
authors: Fácila
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001552:Benzazepines / Q000627:therapeutic use; D018394:CA-125 Antigen / Q000097:blood*; D002304:Cardiac Pacing, Artificial; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002423:Cause of Death; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000628:therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D008991:Monitoring, Physiologic; D009026:Mortality; D009204:Myocardial Revascularization; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010347:Patient Care Planning; D010359:Patient Readmission; D010446:Peptide Fragments / Q000097:blood; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013030:Spain; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001552:Benzazepines; D018394:CA-125 Antigen; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D010446:Peptide Fragments; D049994:Sodium Potassium Chloride Symporter Inhibitors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000077550:Ivabradine
keywords: biomarker guided-therapy; carbohydrate antigen-125; clinical outcomes; clinical trial; heart failure