This Week in Cardiology Sep 19 2025 This Week in Cardiology
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Sep 19, 2025 This week dives into key clinical trials from ESC. The PARACHUTE HF trial showcases a breakthrough in treating Chagas heart failure. DAPA ACT highlights concerns about initiating SGLT2 inhibitors in hospitals despite non-significant outcomes. The AMALFI trial reveals only a modest increase in atrial fibrillation detection through remote ECG screening. A fascinating modeling study discusses the ideal stroke risk threshold for beginning direct oral anticoagulants in atrial fibrillation. Tune in for critical insights and implications!
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BNP-Driven “Win” Masks Clinical Null
- Parachute HF reported superiority of sacubitril-valsartan by a hierarchical win-ratio driven almost entirely by NT-proBNP reduction at 12 weeks.
- Clinical endpoints (CV death, HF hospitalization) were non-significant, making the trial clinically uninformative.
Question Comparator And Endpoint Choices
- Critically appraise comparator choice and endpoint selection before accepting trial claims as practice-changing.
- Avoid adopting costly drugs for resource-limited populations based on biomarker-driven trials alone.
Meta-Analysis Can Mask A Negative Trial
- DAPA-ACT in-hospital dapagliflozin was non-significant for CV death or worsening HF at two months.
- Authors used a meta-analysis to produce positive pooled signals, which may represent spin rather than clear benefit.