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ICYMI: Highlights From ESC Congress 2023
Two major trials presented at the European Society of Cardiology (ESC) 2023 Congress were the STEP-HFpEF and FRAIL-AF trials.
Our top coverage from the European Society of Cardiology (ESC) 2023 Congress in Amsterdam, the Netherlands, included major findings from the STEP-HFpEF and FRAIL-AF studies; an interview with Steven Deitelzweig, MD, on switching from apixaban to rivaroxaban among patients with nonvalvular atrial fibrillation (NVAF); and ESC guideline updates.
Here are the ESC 2023 Congress highlights. Click here to catch up on all of our coverage from the conference.
5. Dr Steven Deitelzweig: Switching From Apixaban to Rivaroxaban Linked to Increased Risks for Patients With NVAF
Steven Deitelzweig, MD, system chairman of hospital medicine at Ochsner Clinical School, presented findings at ESC Congress 2023 indicating that switching from apixaban to rivaroxaban among patients with NVAF was associated with a higher risk of stroke/systemic embolism and major bleeding compared with apixaban continuation. Specifically, switching was associated with a 99% higher risk of stroke/systemic embolism and an 80% increased risk of major bleeding compared with continuation. The study suggests that the safety profile for patients may favor apixaban, and Deitelzweig advised cardiologists to advocate for patients in cases of nonmedical switches and individualize decisions for medical switches.
4. ESC Updates Add SGLT2 Inhibitors Across HF Spectrum, New Diabetes Score, First Guide in Cardiomyopathies
The ESC released an interim update to its guidelines on heart failure (HF) and other related conditions during the conference, reflecting the evolving landscape of therapeutic approaches and new trial results. Notably, it included recommendations on the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors—such as empagliflozin and dapagliflozin—in HF with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF). The guidelines also recommend starting HF therapy before discharge for acute HF, rapid dose escalation with monitoring, and intravenous iron for symptomatic patients with iron deficiency and HF. Additionally, there are updates on treating acute coronary syndromes, endocarditis, and the first international guidelines on cardiomyopathies.
3. Benefits of Semaglutide in Obesity-Related HFpEF Are “Transformational” at Highest BMI Levels, Additional Data Show
A symposium at ESC Congress highlighted additional findings from the STEP-HFpEF trial, revealing that the higher a patient’s initial body mass index (BMI), the greater the benefits of semaglutide in patients with obesity and HFpEF. More than 50% of patients saw improvements of 15 points or more on the Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical summary score after a year of treatment with semaglutide. The study, which examined the relationship between initial BMI and final outcomes, found consistent improvements in outcomes across all obesity categories with semaglutide treatment.
2. Results for Semaglutide Show Obesity Is a “Root Cause” of HFpEF; Payer Coverage Needed, Kosiborod Says
Results from the STEP-HFpEF trial revealed that semaglutide, a once-weekly glucagon-like peptide-1 receptor agonist, helped patients with HFpEF and obesity lose weight, gain physical function, and significantly improve their quality of life. The net weight loss with semaglutide was 10.7% greater than placebo, and patients on semaglutide showed one of the largest gains ever seen on the KCCQ clinical summary score. Mikhail Kosiborod, MD, PhD, the trial’s principal investigator and vice president for research at Saint Luke's Health System, stated that the trial should change the conversation about the role of obesity in HFpEF, emphasizing the need for payer coverage for obesity medications.
1. In a Surprise, Study Finds Frail Elderly Have More Bleeding After Switching From VKAs to NOACs
In our biggest news to come out of ESC Congress this year, results from the FRAIL-AF study revealed that switching from a vitamin K antagonist (VKA) to a novel oral anticoagulant (NOAC) for atrial fibrillation treatment increased the risk of bleeding by 69% in the oldest, frailest patients. The results also showed that making such a switch was not only associated with more bleeding compared with keeping these patients on VKA therapy, but it also did not help prevent strokes. The study included 1330 patients aged 75 and older, and was halted for futility after 163 primary outcome events. The unexpected findings suggest that switching from VKA to NOAC should not be considered for senior patients who are frail and have atrial fibrillation.
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