Practice Update: Cardiology

EUROPEAN SOCIETY OF CARDIOLOGY CONGRESS 16

Professor Garry Jennings discusses the SAVE, NORSTENT, ENSURE-AF and DANISH trials Garry Jennings, AM, MBBS, MD, FRCP, FRACP, Chief Medical Adviser of the Heart Foundation of Australia. Clinical trial updates:

their inhibitors, and SGLT2 inhibitors for diabetes. The meeting also saw the release of important new ESC guidelines that will no doubt influence Australian experts as our own guidelines are revised: revised atrial fibrillation guidelines recommended NOACs over warfarin; heart failure guidelines were updated; dyslipidaemia guidelines took a different line to the US in recommending statins, lifestyle for everyone with dyslipidaemia but not providing targets based on risk level; and the CVD prevention guidelines put great emphasis on the Mediterranean diet, amongst other lifestyle measures.

• ENSURE-AF found that edoxaban was equivalent to warfarin in the prevention of stroke around the time of electrical cardioversion. • A study was presented showing that the CHADS-DS2-Vasc score for defining risk in people with atrial fibrillation overestimates the number of people with low risk. GARFIELD-AF, a new score was proposed. There was also much interest in some new drug classes including PCSK9 inhibitors, powerful LDL- cholesterol lowering agents, dual angiotension receptor blocker/ neprilysin inhibitors for heart failure, new oral anticoagulants (NOACs) and

• The SAVE study was presented by Doug McEvoy from Flinders University in Adelaide and coordinated from the George Institute in Sydney. This international study, with over 2000 people with moderately severe sleep apnoea, examined whether CPAP reduced cardiovascular endpoints shown to be associated with sleep apnoea in observational studies. The result was that CPAP reduced snoring and improved quality of life but had no effect on the combined cardiovascular endpoints or on mortality. Blood pressure was also similar in CPAP and control subjects. Published simultaneously in the New England Journal of Medicine with a supplementary editorial, the study showed that CPAP improves symptoms of sleep apnoea but not outcomes.

The release of important new ESC guidelines will no doubt influence Australian experts as our own guidelines are revised.

• The DANISH trial casts doubts on previously accepted guidelines for the use of ICDs in people with nonischaemic heart failure. • NORSTENT showed no difference in outcomes in a comparison of drug-eluting and bare metal stents. However, revascularisation rates over the next 2 years were less with the former. PRAGUE-18 did not detect a difference between prasugrel and ticagrelor but, like a number of studies where no differences were seen, recruitment failed to meet targets and the study was underpowered.

PRACTICEUPDATE CARDIOLOGY