Clinical trials update: IMPROVEMENT-HF, COPERNICUS, MUSTIC, ASPECT-II, APRICOT and HEART

Important new studies relevant to the field of heart failure reported at th e annual congress of the European Society of Cardiology (ESC), held in Amst erdam in August 2000, are reviewed. The IMPROVEMENT of Heart Failure survey investigated the knowledge and perceptions of over 1300 primary care physi cians from 14 ESC member nations and the actual practice in over 11000 of t heir patients. Guidelines and clinical practice were compared. The survey s uggested, in this large sample, that the quality of care was higher than pr evious smaller surveys have suggested but have also identified important de ficiencies in knowledge and management that should be rectified. The COPERN ICUS study demonstrated that carvedilol was remarkably well tolerated even in patients with very severe heart failure and that treatment was associate d with a substantial reduction in mortality even among patients that would conventionally not be considered, by many, for beta-blocker therapy. The MU STIC trial suggested that cardiac resynchronisation using biventricular pac ing improved patients symptomatically whether or not the patient was in atr ial fibrillation. Morbidity and mortality studies of cardiac resynchronisat ion are now underway. The ASPECT-II and APRICOT-II studies investigated the role of warfarin, aspirin and their combination for the long-term manageme nt of myocardial infarction. One interpretation of the data from these stud ies is that the combination of aspirin and warfarin is about as effective a s warfarin alone but with a much higher incidence of side effects. Warfarin alone appeared superior to aspirin alone. In summary, the annual congress of the ESC provided important new information for clinical practice and, to date, was, by far, the most important cardiology congress in the world thi s year. (C) European Society of Cardiology. All rights reserved.