Early intensive and goal-directed vasodilation was unable to improve outcomes or reduce hospitalizations in patients with acute heart failure (AHF), based on findings from the GALACTIC trial presented Sept. 2 during ESC Congress 2019. "Pulmonary congestion, although the hallmark of AHF, may not be the ideal treatment target," said Principal Investigator Christian Mueller, MD, on the trial's impacts on clinical practice.

The trial randomly assigned 781 patients presenting with acute heart failure at the emergency department to either early goal-directed therapy or standard ESC guideline-based care until hospital discharge. Early, goal-directed therapy involved a combination of high and personalized doses of vasodilators, including sublingual and transdermal nitrates, oral hydralazine for 48 hours to avoid tolerance to nitrates, and ACE inhibitors, angiotensin II receptor blockers (ARBs) or sacubitril/valsartan. The primary endpoint was a composite of all-cause mortality or rehospitalization for AHF at 180 days. Secondary endpoints included quantitative assessment of dyspnea on days two and six.

While overall results showed early intensive and sustained vasodilation using individualized doses was well tolerated, there was no significant improvements in all-cause death or AHF rehospitalizations at 180 days (30.6 percent with intensive vasodilation vs. 27.8 percent with standard care). Mueller and colleagues noted that predefined subgroup analyses showed consistent results according to age and left ventricular ejection fraction, with the exception of statistically significant differences based on sex, suggesting early, goal-directed therapy may possibly be harmful to women.

These findings highlight the fact that AHF will continue to have unacceptably high mortality and morbidity, Mueller said. "Every attempt must be made to prevent HF, detect and treat it early, to avoid progression to AHF."

Keywords: ESC 19, ESC Congress, Heart Failure

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