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Heart Failure Trials โ๏ธ Therapies ๐ FDA Decisions ๐
08/22/2025
Heart Failure Trials โ๏ธ Therapies ๐ FDA Decisions ๐
๐จ New in JACC (Aug 2025): Evidentiary Landscape of HF Therapies ๐ซ Over the last decade, the heart failure field has shifted from the โmortality reduction eraโ (ACEIs, ฮฒ-blockers, MRAs) โก๏ธ to the โhospitalization reduction eraโ (SGLT2i, ARNI in HFpEF, iron therapy). ๐ Key Insights: โ๏ธ FDA decisions reflect both rigor and flexibility โ approving sacubitril/valsartan in HFpEF despite a missed primary endpoint, while rejecting omecamtiv mecarbil despite statistical significance. ๐งฌ Enrichment strategies (NT-proBNP, iron indices, recent WHF) drive modern trial design, boosting efficiency but limiting mortality signals. ๐ Composite endpoints (CV death + HHF) dominate, making hospitalization reduction the most reproducible outcome. ๐ Guidelines now anchor on ARNI + SGLT2i in HFrEF and SGLT2i in HFpEF, with emerging roles for finerenone and incretin-based therapies. ๐ Big picture: Clinical practice is evolving, but the โholy grailโ of new mortality-reducing therapies remains elusive. #HeartFailure #Cardiology #ClinicalTrials #FDA #JACC
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