None listed
Conditions
Brief summary
Patients have echocardiograms within 1-2 days of a heart attack. Those with low heart function are started on multiple medications for heart failure based on chronic heart failure studies. However, for half, this is temporary stunning of the heart muscle that will spontaneously resolve within 2 weeks. Therefore, many patients are discharged and up titrated on drugs that may not be necessary. When an echocardiogram shows full recovery months later, it is difficult to stop these drugs as it is not known if they led to improvement in heart function. In this study, a repeat echocardiogram is done at 2 weeks, and if normal, participants will be randomised to continuing or stopping current heart failure medications. A repeat echocardiogram is done at 3 and 6 months to assess heart function. The aim of this is to see if we should be reassessing heart function before initiating lifelong multiple medications.
Interventions
Those who have recovered left ventricular ejection fraction (LVEF)> or = 50% at 2 -3 weeks post discharge (n=90) are randomised in 2:1 randomisation fashion to: stopping medications other than angiotensin converting enzyme inhibitors (ACEi)i/ angiotensin receptor blocker (ARB ) if indicated by a cardiologist . The intervention group will comprise 2/3 of patients and control group 1/3.. Down titration will be done according to local practice , but likely not necessary in most as patients will h
Those who have recovered left ventricular ejection fraction (LVEF)> or = 50% at 2 -3 weeks post discharge (n=90) are randomised in 2:1 randomisation fashion to: stopping medications other than angiotensin converting enzyme inhibitors (ACEi)i/ angiotensin receptor blocker (ARB ) if indicated by a cardiologist . The intervention group will comprise 2/3 of patients and control group 1/3.. Down titration will be done according to local practice , but likely not necessary in most as patients will have been started medication 2 weeks previously.. adherence to study intervention will be from prescription records online.
Sponsors
Auckland City Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age >18 years of age 2. Able to give informed consent 3. LVEF <40% post type 1 AMI who have recovered to >50% at week 2 echo 4. Revascularised by percutaneous coronary intervention (PCI) during admission
Exclusion criteria
1. previous known cardiomyopathy 2. Atrial fibrillation 3. Clinical heart failure at time of MI or since discharge 4. Significant mitral or aortic valve disease 5. Planned staged percutaneous intervention (PCI)/coronary artery bypass graft (CABG) 6. LVEF>41% at baseline echocardiogram 7. LVEF<50% at 2-week echocardiogram
Outcome results
None listed