Heart Failure Again Takes Center Stage at ESC

The fruits of continued work on SGLT2 inhibitors in the background of a global pandemic will be highlighted this weekend when the European Society of Cardiology (ESC) reconvenes for another virtual meeting.

During Friday’s Hot Line session, the audience will finally get the details of the EMPEROR-Preserved trial and learn just how successful the SGLT2 inhibitor empagliflozin (Jardiance) was in heart failure with preserved ejection fraction (HFpEF), a condition with notoriously few therapeutic options.

Boehringer Ingelheim and Eli Lilly had drummed up intrigue for this presentation by announcing that the phase III trial met its primary endpoint in July.

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Thanks to EMPEROR-Reduced, which took the same digital ESC stage last year, empagliflozin recently won an expanded indication for heart failure with reduced ejection fraction (HFrEF) — if all goes well in EMPEROR-Preserved, the diabetes drug may be on its way to FDA approval for HFpEF.

New heart failure guidelines also make their debut on the first day of this year’s ESC. With the established success of empagliflozin and dapagliflozin (Farxiga) in heart failure, will SGLT2 inhibitor therapy be incorporated as another pillar of treatment according to European recommendations?

ESC attendees can also expect a trickling in of other clinical guidelines throughout the meeting: one on valvular heart disease on Saturday, one on cardiac pacing on Sunday, and one on cardiovascular disease prevention on Monday.

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Other highlights of the Hot Line scientific program include:

  • GUIDE-HF: A trial testing CardioMEMS pulmonary artery pressure monitoring for guidance of heart failure management beyond the currently indicated group of patients
  • ENVISAGE-TAVI AF: A matchup between the direct oral anticoagulant edoxaban (Savaysa) and vitamin K antagonists for patients with atrial fibrillation after transcatheter aortic valve replacement
  • FIGARO-DKD and FIDELITY: Two trials probing cardiovascular and kidney outcomes with finerenone (Kerendia) as an add-on to standard therapy for patients with chronic kidney disease and type 2 diabetes
  • TOMAHAWK: A randomized study of immediate versus delayed or selective coronary angiography for survivors of out-of-hospital cardiac arrest without ST-segment elevation
  • ACST-2: A trial of carotid artery stenting versus carotid endarterectomy in asymptomatic patients
  • SSaSS: A cluster-randomized trial of salt substitution’s effects on stroke and cardiovascular events in older people with high blood pressure
  • IAMI: A study of flu vaccination for heart attack survivors

There will also be sessions dedicated to sudden cardiac death and COVID-19, according to Stephan Windecker, MD, of Bern University Hospital in Switzerland, who is chair of the conference program committee.

This year, ESC is back to charging registration fees for attendees. As of Thursday, there were more than 35,000 people registered from 162 countries, Windecker said during the opening press conference.

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That is a sharp drop-off from the more than 100,000 attendees registered last year when the conference — the first to be held virtually due to the pandemic — was free to attend.

  • Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

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