Douglas L Mann1, Randall J Lee2, Andrew J S Coats3, Gheorghe Neagoe4, Dinu Dragomir5, Enrico Pusineri6, Massimo Piredda6, Luca Bettari7, Bridget-Anne Kirwan8, Robert Dowling9, Maurizio Volterrani10, Scott D Solomon11, Hani N Sabbah12, Andy Hinson13, Stefan D Anker14. 1. Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA. 2. Department of Medicine, University of California-San Francisco, San Francisco, CA, USA. 3. Monash University, Melbourne, Australia and University of Warwick, Warwick, UK. 4. Military Hospital Bucharest, Bucharest, Romania. 5. Spitalul Clinic De Urgenta MAI, Bucharest, Romania. 6. Cardio-thoracic Center, Istituto Clinico Sant'Ambrogio, Milan, Italy. 7. Istituti Ospitalieri di Cremona, Cremona, Italy. 8. SOCAR Research SA, Nyon, Switzerland. 9. Dowling Consulting, Louisville, KY, USA. 10. IRCCS San Raffaele, Rome, Italy. 11. Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. 12. Henry Ford Health System, Detroit, MI, USA. 13. LoneStar Heart Inc., Laguna Hills, CA, USA. 14. Innovative Clinical Trials, Department of Cardiology and Pneumonology, University Medical Centre Göttingen (UMG), Göttingen, Germany.
Abstract
AIMS: AUGMENT-HF was an international, multicentre, prospective, open-label, randomized, controlled evaluation testing the hypothesis that Algisyl (injectable calcium alginate hydrogel) is superior to standard medical therapy (SMT) for improving functional capacity and clinical outcomes in patients with advanced heart failure (HF). We previously reported results following 6 months of follow-up. This report presents the results from 1 year of extended follow up for this clinical trial. METHODS AND RESULTS: We enrolled 78 patients with advanced HF, randomized (1:1), to Algisyl with SMT or SMT alone as previously reported. Patient inclusion criteria were LVEF ≤35%, peak VO2 of 9.0-14.5 mL/min/kg and LV end-diastolic diameter (LVEDD) index 30-40 mm/m(2) (LVEDD/body surface area). Patients must have been on stable, evidence-based therapy for HF. A total of 58 patients, mean age 62.3 ±9.6 years, with ischaemic (57.7%) or non-ischaemic (42.3%) HF completed 12 months of follow-up. Treatment with Algisyl was associated with improved peak VO2 at 12 months; treatment effect vs. control of +2.10 mL/kg/min (95% confidence interval 0.96-3.24, P < 0.001). Statistically significant improvements were observed for VO2 at anaerobic threshold, 6-min walk test distance, and NYHA functional class (all P < 0.001). Through 12 months of follow-up there were 4 (10.5%) deaths in the control group and 9 (22.5%) deaths in the Algisyl group. CONCLUSIONS: Algisyl in addition to SMT was more effective than SMT alone for providing sustained 1-year benefits in exercise capacity, symptoms, and clinical status for patients with advanced HF. These data support larger clinical evaluations of this novel therapy.
RCT Entities:
AIMS: AUGMENT-HF was an international, multicentre, prospective, open-label, randomized, controlled evaluation testing the hypothesis that Algisyl (injectable calcium alginate hydrogel) is superior to standard medical therapy (SMT) for improving functional capacity and clinical outcomes in patients with advanced heart failure (HF). We previously reported results following 6 months of follow-up. This report presents the results from 1 year of extended follow up for this clinical trial. METHODS AND RESULTS: We enrolled 78 patients with advanced HF, randomized (1:1), to Algisyl with SMT or SMT alone as previously reported. Patient inclusion criteria were LVEF ≤35%, peak VO2 of 9.0-14.5 mL/min/kg and LV end-diastolic diameter (LVEDD) index 30-40 mm/m(2) (LVEDD/body surface area). Patients must have been on stable, evidence-based therapy for HF. A total of 58 patients, mean age 62.3 ± 9.6 years, with ischaemic (57.7%) or non-ischaemic (42.3%) HF completed 12 months of follow-up. Treatment with Algisyl was associated with improved peak VO2 at 12 months; treatment effect vs. control of +2.10 mL/kg/min (95% confidence interval 0.96-3.24, P < 0.001). Statistically significant improvements were observed for VO2 at anaerobic threshold, 6-min walk test distance, and NYHA functional class (all P < 0.001). Through 12 months of follow-up there were 4 (10.5%) deaths in the control group and 9 (22.5%) deaths in the Algisyl group. CONCLUSIONS:Algisyl in addition to SMT was more effective than SMT alone for providing sustained 1-year benefits in exercise capacity, symptoms, and clinical status for patients with advanced HF. These data support larger clinical evaluations of this novel therapy.
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