Time-travelling through the evidence behind classical HF medications in 8 tweets, based on Prof Marc Pfeffer'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

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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/10.1056/NEJM199108013250502

(Prof Pfeffers #ESCCongress talk)

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Evidence for benefit of ACEi in asymptomatic pts with LVSD followed from the SOLVD investigators in 1992 who showed 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/10.1056/NEJM199209033271003

(Prof Pfeffers #ESCCongress talk)

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

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

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

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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/lancet/article/PIIS0140-6736(99)04440-2/fulltext
https://www.nejm.org/doi/full/10.1056/NEJM200105313442201

(Prof Pfeffers #ESCCongress talk)
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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/10.1056/NEJMoa030207

(Prof Pfeffers #ESCCongress talk)
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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 Pfeffers #ESCCongress talk)
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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

#ESCCongress #HF

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