Carbohydrate antigen 125-guided therapy (CA125-strategy) was superior compared to standard of care in reducing death and acute heart failure readmission, according to results from the CHANCE-HF (Carbohydrate Antigen 125-guided Therapy in Acute Heart Failure) trial.
Julio Núñez, MD, of Hospital Clínico Universitario in Valenica, Spain, and colleagues conducted a prospective multicenter randomized trial to compare the CA125-strategy and standard of care after hospitalization for acute heart failure. Their findings were published in JACC: Heart Failure.
“In recent years, CA125, a widely available biomarker used for ovarian cancer monitoring, has emerged as a potential surrogate of fluid retention and inflammation activity in AHF [acute heart failure],” the authors wrote. “Published data has shown that high levels of this glycoprotein, which is present in up to two-thirds of patients hospitalized for AHF, correlate with the severity of AHF and relate to morbidity and mortality.”
After discharge for acute heart failure, 380 patients (mean age: 73.7 ± 11.1 years; 44.2% female) were randomly assigned to receive CA125-strategy (n=187) or standard of care (n=193).
The primary end point was a 1-year composite of death and acute heart failure readmission. Secondary end points included the composite of 1-year death or readmission for any cause, all-cause mortality and the number of days out of the hospital, recurrent hospitalizations, worsening heart failure episodes not requiring hospitalization, and depiction of CA125 and natriuretic peptides’ trajectories during follow-up.
Patients who were in the CA125-strategy group had more ambulatory visits compared to those in the standard of care group (5.97 vs 5.23 visits/person-years, respectively; incidence rate ratio [IRR]: 1.14; P=.003). There was no difference in prescription frequencies for many therapeutic agents between groups. However, statins were more frequently prescribed in the CA125-strategy group, both at randomization (82.4% vs 53.4%; P<.001) and at the trial end (78.1% vs 41.5%; P<.001).
For the primary end point, CA125-strategy significantly reduced the proportion of events (35.3% vs 43.5%; P=.101). In addition, on average, patients in the CA125-strategy had 30 days more time free of events in a 1-year framework.
The composite of death and/or any rehospitalization occurred in 44.9% of CA125-strategy patients vs 50.3% of standard of care patients (P=.297), whereas there were no differences in all-cause mortality and days alive and out of hospital between the 2 arms.
Rate of recurrent acute heart failure and all-cause hospitalizations were significantly reduced using the CA125-strategy (85 vs 165 recurrent heart failure events; IRR: 0.49; 95% confidence interval [CI]: 0.28-0.82; P=.008 and 132 vs 202 all-cause hospitalizations; IRR: 0.61; 95% CI: 0.39-0.96; P=.033).
“Larger studies are needed to confirm our results and define the real clinical impact of the CA125-guided therapy after an episode of AHF,” researchers concluded.
Núñez J, Llàcer P, Bertomeu-González V, et al; for the CHANCE-HF Investigators. Carbohydrate antigen 125-guided therapy in acute heart failure (CHANCE-HF). A randomized study. JACC Heart Fail. 2016. doi:10.1016/j.jchf.2016.06.007.