Worsening heart failure: Goal should be symptom relief?

Paul J. Hauptman, M.D., a SLUCare cardiologist specializing in heart failure and professor of internal medicine at Saint Louis University School of Medicine, looked at the results of the Trial of Ularitide Efficacy and Safety in Acute Heart Failure (TRUE-AHF), which was designed to evaluate the safety and efficacy of a novel synthetic compound "ularitide" administered very soon after a patient presents with acute decompensated heart failure (ADHF).

ADHF is a sudden worsening of the signs and symptoms of heart failure, which typically includes difficulty breathing (dyspnea), leg or feet swelling, and fatigue.

Hauptman's editorial, "Disease Modification in Acute Decompensated Heart Failure," was published online April 12 ahead of print publication in the New England Journal of Medicine.

Hauptman's review of the TRUE-AHF trial looked at the two hypotheses being tested -- that a single infusion of ularitide would improve early clinical outcomes and that a rapid treatment approach to exacerbation of heart failure improves longer-term survival.

"We can conclude that ularitide, like its predecessor nesiritide, has limited short-term effects that wane after the discontinuation of treatment, which lessens the likelihood that there is a constructive avenue for further development of natriuretic peptides," Hauptman wrote in his editorial. "It also appears that we do not have a mandate to establish rapid-response teams for patients who present with acute decompensated heart failure."

Hauptman notes the need for greater consensus on how to define the response to intervention and to determine which patients are in greatest therapeutic need.

"Exacerbations of chronic disease reflect the chronic disease, not the hospitalizations used to manage those exacerbations,"

Hauptman wrote. "The search for improved understanding of the pathophysiology of heart-failure decompensation continues, and so does the search for better treatments."

Hauptman has a background in clinical and outcomes research in heart failure. He has been an investigator in multiple trials for more than 20 years. In 2014, Hauptman was named the editor-in-chief of the Journal of Cardiac Failure. In 2016, Hauptman was named an inaugural Fellow of the Heart Failure Society of America (HFSA).