Thread by @sarahhudsonuk, Time-travelling through the evidence behind classical HF medications in 8 tweets, based [...]

Time-travelling through the evidence behind classical HF medications in 8 tweets, based on Prof Marc Pfeffer& #39;s stunning #ESCCongress talk. Links to key papers included.

Starting in 1986: evidence is published for hydralazine & isosorbide dinitrate

https://www.nejm.org/doi/full/10.1056/NEJM198606123142404

1/">https://www.nejm.org/doi/full/...

In 1987 came evidence for ACEi in pts with symptomatic LVSD with the CONSENSUS trial, with the superiority of ACEi over hydralazine and nitrates proved in 1991

https://www.nejm.org/doi/full/10.1056/NEJM198706043162301
https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJM199108013250502

(Prof">https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)

2/

https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)2/" title="In 1987 came evidence for ACEi in pts with symptomatic LVSD with the CONSENSUS trial, with the superiority of ACEi over hydralazine and nitrates proved in 1991 https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJM199108013250502(Prof">https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)2/">

Evidence for benefit of ACEi in asymptomatic pts with LVSD followed from the SOLVD investigators in 1992 who showed

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten">hospitalisations (mortality benefit was shown with 12 yr FU in 2003)

https://www.nejm.org/doi/full/10.1056/NEJM199209033271003
https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJM199209033271003

(Prof">https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)

3/

Evidence for benefit of ACEi in asymptomatic pts with LVSD followed from the SOLVD investigators in 1992 who showed https://abs.twimg.com/emoji/v2/... draggable=

hospitalisations (mortality benefit was shown with 12 yr FU in 2003) https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJM199209033271003(Prof">https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)3/" title="Evidence for benefit of ACEi in asymptomatic pts with LVSD followed from the SOLVD investigators in 1992 who showed https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten">hospitalisations (mortality benefit was shown with 12 yr FU in 2003) https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJM199209033271003(Prof">https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)3/">

Then followed a period of disappointment with trials of inotropic drugs–PROMISE, PROFILE&VEST–which showed

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben">mortality

The DIG trial (digoxin,1997) showed a positive effect-

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten">hospitalisations

https://www.nejm.org/doi/full/10.1056/NEJM199111213252103
https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJM199812173392503
https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJM199702203360801

4/">https://www.nejm.org/doi/full/...

mortalityThe DIG trial (digoxin,1997) showed a positive effect-https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten">hospitalisations https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJM199812173392503" title="Then followed a period of disappointment with trials of inotropic drugs–PROMISE, PROFILE&VEST–which showed https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben">mortalityThe DIG trial (digoxin,1997) showed a positive effect-https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten">hospitalisations https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJM199812173392503">

Evidence for BB in #HF came in 1999 from CIBIS II and MERIT HF, with further evidence from COPERNICUS in 2001

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)11181-9/fulltext
https://www.thelancet.com/journals/... href=" https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)04440-2/fulltext
https://www.thelancet.com/journals/... href=" https://www.nejm.org/doi/full/10.1056/NEJM200105313442201

(Prof">https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)
5/

Evidence for BB in #HF came in 1999 from CIBIS II and MERIT HF, with further evidence from COPERNICUS in 2001 https://www.thelancet.com/journals/... href=

Moving forward to 1999 came RALES, supporting spironolactone use, following by EPHESUS in 2003 giving evidence for eplerenone in pts with LVSD post MI.

https://www.nejm.org/doi/full/10.1056/NEJM199909023411001
https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJMoa030207

(Prof">https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)
6/

https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)6/" title="Moving forward to 1999 came RALES, supporting spironolactone use, following by EPHESUS in 2003 giving evidence for eplerenone in pts with LVSD post MI. https://www.nejm.org/doi/full/... href=" https://www.nejm.org/doi/full/10.1056/NEJMoa030207(Prof">https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)6/" class="img-responsive" style="max-width:100%;"/>

EMPHASIS in 2011 added to the evidence for eplerenone, this time in pts with LVSD and mild symptoms, and provided the ‘missing piece’ of the aldosterone-antagonist evidence jigsaw.

https://www.nejm.org/doi/full/10.1056/NEJMoa1009492

(Prof">https://www.nejm.org/doi/full/... Pfeffers #ESCCongress talk)
7/

Prof Pfeffer’s talk squeezed an incredible amount into 12 minutes. It didn’t manage to fit in ARB evidence, and salcubitril-valsartan and the SGLT2 inhibitors were beyond its covered time period.

It is definitely worth a view - https://esc2020.escardio.org/detail/video/ref:P209752

https://esc2020.escardio.org/detail/vi... href="https://twtext.com//hashtag/ESCCongress"> #ESCCongress #HF

8/8

#ESCCongress #HF8/8" title="Prof Pfeffer’s talk squeezed an incredible amount into 12 minutes. It didn’t manage to fit in ARB evidence, and salcubitril-valsartan and the SGLT2 inhibitors were beyond its covered time period. It is definitely worth a view - https://esc2020.escardio.org/detail/vi... href="https://twtext.com//hashtag/ESCCongress"> #ESCCongress #HF8/8" class="img-responsive" style="max-width:100%;"/>

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