Comparison of investigator-reported and centrally adjudicated heart failure outcomes in the EMPEROR-preserved trial : heart failure

Background - There is limited published information on outcome adjudication in heart failure (HF) trials, particularly in heart failure with preserved ejection fraction (HFpEF). - Objectives - The study sought to compare investigator reports with clinical events committee (CEC) adjudication and asse...

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Hauptverfasser: Carson, Peter (VerfasserIn) , Teerlink, John R. (VerfasserIn) , Komajda, Michel (VerfasserIn) , Anand, Inder (VerfasserIn) , Packer, Milton (VerfasserIn) , Butler, Javed (VerfasserIn) , Doehner, Wolfram (VerfasserIn) , Ferreira, João Pedro (VerfasserIn) , Filippatos, Gerasimos (VerfasserIn) , Haass, Markus (VerfasserIn) , Miller, Alan (VerfasserIn) , Pehrson, Steen (VerfasserIn) , Pocock, Stuart J. (VerfasserIn) , Iwata, Tomoko (VerfasserIn) , Brückmann, Martina (VerfasserIn) , Gasior, Tomasz (VerfasserIn) , Zannad, Faiez (VerfasserIn) , Anker, Stefan D. (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: May 2025
In: JACC Heart failure
Year: 2025, Jahrgang: 13, Heft: 5, Pages: 710-721
ISSN:2213-1787
DOI:10.1016/j.jchf.2024.10.021
Online-Zugang:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jchf.2024.10.021
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S2213177924008552
Volltext
Verfasserangaben:Peter Carson, MD, John R. Teerlink, MD, Michel Komajda, MD, Inder Anand, MD, Milton Packer, MD, Javed Butler, MD, Wolfram Doehner, MD, João Pedro Ferreira, MD, Gerasimos Filippatos, MD, Markus Haass, MD, Alan Miller, MD, Steen Pehrson, MD, Stuart J. Pocock, PHD, Tomoko Iwata, MSc, Martina Brueckmann, MD, Tomasz Gasior, MD, Faiez Zannad, MD, Stefan D. Anker, MD

MARC

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245 1 0 |a Comparison of investigator-reported and centrally adjudicated heart failure outcomes in the EMPEROR-preserved trial : heart failure  |c Peter Carson, MD, John R. Teerlink, MD, Michel Komajda, MD, Inder Anand, MD, Milton Packer, MD, Javed Butler, MD, Wolfram Doehner, MD, João Pedro Ferreira, MD, Gerasimos Filippatos, MD, Markus Haass, MD, Alan Miller, MD, Steen Pehrson, MD, Stuart J. Pocock, PHD, Tomoko Iwata, MSc, Martina Brueckmann, MD, Tomasz Gasior, MD, Faiez Zannad, MD, Stefan D. Anker, MD 
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520 |a Background - There is limited published information on outcome adjudication in heart failure (HF) trials, particularly in heart failure with preserved ejection fraction (HFpEF). - Objectives - The study sought to compare investigator reports with clinical events committee (CEC) adjudication and assess the impact of the SCTI (Standardized Data Collection for Cardiovascular Trials) criteria. - Methods - In the EMPEROR-Preserved (EMPagliflozin outcome tRial in Patients with chronic heart Failure With Preserved Ejection Fraction) trial, we compared investigator reports with CEC for concordance, treatment effect on primary composite outcome events and components (first event primary heart failure hospitalization [HHF] or cardiovascular [CV] mortality), prognosis after first HHF, total HHF, and trial duration with and without SCTI criteria. - Results - The CEC confirmed 67.4% investigator-reported events for the primary outcome (CV mortality 82.7%, HHF 66.3%). The HR for treatment effect did not differ between adjudication methods for the primary outcome: investigator reports (HR: 0.77; 95% CI: 0.69-0.87), CEC (HR: 0.79; 95% CI: 0.69-0.90), its components, or total HHFs. The prognosis after the first HHF for all-cause mortality and CV mortality also did not differ between investigator reports and the CEC, nor did investigator reports and HHFs with a different CEC cause. SCTI criteria were present in 92% of CEC HHFs with a similar treatment effect to non-SCTI criteria. The investigator-reported primary events reached the protocol target number 6 months earlier than the CEC (7 months with full SCTI criteria). - Conclusions - Investigator adjudication is an alternative to a CEC with similar accuracy and faster event accumulation in HFpEF. The use of granular (SCTI) criteria did not improve trial performance. Our data suggest that a broader definition of an HHF event could be particularly beneficial in HFpEF clinical trials. (EMPagliflozin outcome tRial in Patients with chronic heart Failure With Preserved Ejection Fraction; NCT03057951). 
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