Daily Cardiology Research Analysis
Three impactful cardiology studies this cycle refine practice across prevention and heart failure care: a large randomized trial (DANCAVAS II) found no mortality benefit and more severe bleeding with comprehensive CT-based cardiovascular screening in 60–64-year-old men; a double-blind RCT (DAPA ACT HF-TIMI 68) showed neutral early outcomes for in-hospital dapagliflozin initiation yet, together with a prespecified meta-analysis, supports early SGLT2 inhibitor use; and the VICTOR trial reported re
Summary
Three impactful cardiology studies this cycle refine practice across prevention and heart failure care: a large randomized trial (DANCAVAS II) found no mortality benefit and more severe bleeding with comprehensive CT-based cardiovascular screening in 60–64-year-old men; a double-blind RCT (DAPA ACT HF-TIMI 68) showed neutral early outcomes for in-hospital dapagliflozin initiation yet, together with a prespecified meta-analysis, supports early SGLT2 inhibitor use; and the VICTOR trial reported reduced cardiovascular and all-cause mortality with vericiguat in ambulatory HFrEF.
Research Themes
- Population screening and bleeding risk trade-offs
- Early initiation of SGLT2 inhibitors during HF hospitalization
- Soluble guanylate cyclase stimulation reducing mortality in HFrEF
Selected Articles
1. Dapagliflozin in Patients Hospitalized for Heart Failure: Primary Results of the DAPA ACT HF-TIMI 68 Randomized Clinical Trial and Meta-Analysis of Sodium-Glucose Cotransporter-2 Inhibitors in Patients Hospitalized for Heart Failure.
In 2401 patients hospitalized for heart failure, in-hospital initiation of dapagliflozin did not significantly reduce cardiovascular death or worsening HF through 2 months (HR 0.86, 95% CI 0.68–1.08). A prespecified meta-analysis of trials of in-hospital SGLT2i initiation suggests early benefits on cardiovascular and all-cause outcomes, supporting early use when clinically appropriate.
Impact: This double-blind RCT directly informs the timing of SGLT2 inhibitor initiation during HF hospitalization and, coupled with a prespecified meta-analysis, refines early discharge planning.
Clinical Implications: While short-term outcomes were neutral, the aggregate evidence supports starting SGLT2 inhibitors before discharge if hemodynamically stable, integrating them early into guideline-directed therapy and not delaying initiation to outpatient follow-up.
Key Findings
- Primary composite (CV death or worsening HF through 2 months) HR 0.86 (95% CI 0.68–1.08), not statistically significant.
- Randomized, double-blind, placebo-controlled design with 2401 hospitalized HF patients; 71.5% with LVEF ≤40%.
- Prespecified meta-analysis indicates early reduction in CV death/worsening HF and all-cause mortality with in-hospital SGLT2i initiation.
Methodological Strengths
- Randomized, double-blind, placebo-controlled, multicenter design
- Prespecified meta-analysis complements trial findings to contextualize early outcomes
Limitations
- Short primary time horizon (2 months) may miss accruing benefits
- Neutral primary endpoint limits definitive conclusions on isolated trial results
Future Directions: Evaluate patient phenotypes and hemodynamic states most likely to benefit from in-hospital SGLT2i initiation and extend follow-up to capture medium-term outcomes and rehospitalizations.
2. Outcomes of cardiovascular screening in men aged 60-64 years: the DANCAVAS II trial.
In this population-based randomized trial of 31,268 men aged 60–64, invitation to comprehensive CT-based cardiovascular screening did not reduce all-cause mortality or MACE over 7 years but increased severe bleeding (HR 1.18). The trial is powered for 10-year outcomes; continued follow-up is planned.
Impact: This large pragmatic RCT challenges assumptions about the benefits of broad CT-based screening in younger seniors, highlighting bleeding harms and informing population-level prevention strategies.
Clinical Implications: Routine comprehensive CT-based screening for subclinical CVD in men aged 60–64 should not be adopted for mortality reduction and requires careful consideration of bleeding risk; individualized risk assessment and targeted prevention remain preferable.
Key Findings
- No significant reduction in all-cause mortality (HR 0.94, p=0.169) or MACE (HR 0.96, p=0.319) over a median of 7 years.
- Severe bleeding events were more frequent in the screening invitation arm (HR 1.18, 95% CI 1.05–1.32), including higher gastrointestinal bleeding risk.
- Trial powered for 10-year outcomes; only 62.6% of invited men attended screening, reflecting real-world uptake.
Methodological Strengths
- Population-based, randomized design with large sample size
- Comprehensive imaging plus standardized downstream preventive interventions
Limitations
- Interim analysis at 7 years for a trial powered at 10 years may underdetect mortality differences
- Invitation strategy with 62.6% uptake may dilute per-protocol effects
Future Directions: Report 10-year outcomes; assess net clinical benefit frameworks incorporating bleeding; explore targeted screening strategies focused on higher-risk subgroups.
3. Vericiguat and mortality in heart failure and reduced ejection fraction: the VICTOR trial.
Among 6105 ambulatory HFrEF patients, vericiguat reduced cardiovascular mortality (HR 0.83) and all-cause mortality (HR 0.84) over a median 19.7 months, with consistent reductions in sudden cardiac and HF-related deaths across subgroups. Although the primary composite was neutral, the prespecified mortality analyses show clinically meaningful benefit.
Impact: Demonstrates mortality reduction with sGC stimulation in well-treated ambulatory HFrEF, strengthening its positioning alongside guideline-directed therapy.
Clinical Implications: Vericiguat may be considered to reduce cardiovascular and all-cause mortality in ambulatory HFrEF beyond standard therapy, especially in patients with elevated risk profiles, while recognizing the primary composite neutrality.
Key Findings
- Cardiovascular mortality reduced with vericiguat vs placebo (HR 0.83, 95% CI 0.71–0.97; P=0.020).
- All-cause mortality reduced (HR 0.84, 95% CI 0.74–0.97; P=0.015).
- Lower sudden cardiac death (HR 0.75) and HF-related death (HR 0.71); benefits consistent across subgroups and NT-proBNP levels.
Methodological Strengths
- Large, double-blind, placebo-controlled randomized design
- Prespecified secondary mortality endpoints with adequate power
Limitations
- Primary composite endpoint was neutral, which may temper guideline uptake
- Ambulatory, stable HFrEF population without recent worsening may limit generalizability to decompensated HF
Future Directions: Define patient phenotypes with greatest absolute mortality benefit, integrate cost-effectiveness, and test combinations with SGLT2 inhibitors and ARNI in pragmatic settings.