Author + information
- Received March 1, 2016
- Revision received June 23, 2016
- Accepted June 23, 2016
- Published online November 1, 2016.
- Julio Núñez, MDa,∗ (, )
- Pau Llàcer, MDb,
- Vicente Bertomeu-González, MDc,
- Maria José Bosch, MDd,
- Pilar Merlos, MDe,
- Sergio García-Blas, MDa,
- Vicente Montagud, MDf,
- Vicent Bodí, MDa,
- Vicente Bertomeu-Martínez, MDc,
- Valle Pedrosa, MDe,
- Andrea Mendizábal, MDb,
- Alberto Cordero, MDc,
- Jorge Gallego, MDd,
- Patricia Palau, MDd,
- Gema Miñana, MDa,
- Enrique Santas, MDa,
- Salvador Morell, MDf,
- Angel Llàcer, MDa,
- Francisco J. Chorro, MDa,
- Juan Sanchis, MDa,
- Lorenzo Fácila, MDf,
- CHANCE-HF Investigators
- aServicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- bServicio de Medicina Interna, Hospital de Manises, Valencia, Spain
- cServicio de Cardiología, Hospital de San Juan, Alicante, Spain
- dServicio de Medicina Interna, Hospital de la Plana, Castellón, Spain
- eServicio de Cardiología, Hospital de Manises, Valencia, Spain
- fServicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
- ↵∗Reprint requests and correspondence:
Dr. Julio Núñez, Servicio de Cardiología, Hospital Clínico Universitario, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain.
Objectives This study sought to evaluate the prognostic effect of carbohydrate antigen-125 (CA125)–guided therapy (CA125 strategy) versus standard of care (SOC) after a hospitalization for acute heart failure (AHF).
Background CA125 has emerged as a surrogate of fluid overload and inflammatory status in AHF. After an episode of AHF admission, elevated values of this marker at baseline as well as its longitudinal profile relate to adverse outcomes, making it a potential tool for treatment guiding.
Methods In a prospective multicenter randomized trial, 380 patients discharged for AHF and high CA125 were randomly assigned to the CA125 strategy (n = 187) or SOC (n = 193). The aim in the CA125 strategy was to reduce CA125 to ≤35 U/ml by up or down diuretic dose, enforcing the use of statins, and tightening patient monitoring. The primary endpoint was 1-year composite of death or AHF readmission. Treatment strategies were compared as a time to first event and longitudinally.
Results Patients allocated to the CA125 strategy were more frequently visited, and treated with ambulatory intravenous loop diuretics and statins. Likewise, doses of oral loop diuretics and aldosterone receptor blockers were more frequently modified. The CA125 strategy resulted in a significant reduction of the primary endpoint, whether evaluated as time to first event (66 events vs. 84 events; p = 0.017) or as recurrent events (85 events vs. 165 events; incidence rate ratio: 0.49; 95% confidence interval: 0.28 to 0.82; p = 0.008). The effect was driven by significantly reducing rehospitalizations but not mortality.
Conclusions The CA125 strategy was superior to the SOC in terms of reducing the risk of the composite of 1-year death or AHF readmission. This effect was mainly driven by significantly reducing the rate of rehospitalizations. (Carbohydrate Antigen-125-guided Therapy in Heart Failure [CHANCE-HF]; NCT02008110)
This study was funded with public funds obtained in competitive calls: grant EC10-108 of the Ministry of Health Call for Independent Clinical Research in year 2010. The authors also received the support of CAIBER (CAI11/01/0039), SCReN-Spanish Clinical Research Network (PT13/0002/0031) from the National R+D+I Plan of the Institute of Health Carlos III (Ministry of Economy and Competitiveness: Co-financed by European Regional Development Fund “A way to make Europe”), Red de Investigación Cardiovascular, Programa 7 (RD12/0042/0010 and RD/12/0042/0068) FEDER, and PIE15/00013. Dr. Núñez received support to organize a CHANCE-HF researcher meeting at 2012 and 2013 by Servier and Ferrer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 1, 2016.
- Revision received June 23, 2016.
- Accepted June 23, 2016.
- American College of Cardiology Foundation