Multi-centre study to examine new approach to treat patients with heart failure

Doctors here are leading a multi-centre study to test a new approach to managing a form of heart failure which has no current treatment proven to reduce death rates or hospitalisations.

In Singapore, heart failure is the most common cause of cardiac hospitalisation, with only 32% of cases surviving beyond five years. About 30%-50% of heart failure patients here suffer from a particular type of heart failure known as preserved ejection fraction. The three-year trial will focus on patients who present with such a disease. In such patients, their small, stiff hearts are often not dilated, can still pump with reasonable strength, but fill poorly and inefficiently, resulting in poor exercise capacity and high death rates.

Treatments that help when heart pumping action is poor are of no benefit to this group of patients. However, recently, a simple catheter procedure removing excess nerve signals to and from the kidneys (known as renal denervation) has been able to reduce blood pressure in patients with high blood pressure resistant to multi-drug treatment.

Removing excess nerve drive to the kidneys, heart and blood circulation holds promise as a treatment to patients with stiff hearts, as it is hoped that the treatment will improve the exercise capacity and functional status of the stiff heart, allowing it to fill more efficiently as well as reduce fibrosis and inflammation around the organ. The study is being led by Associate Professor Carolyn Lam of the National University Heart Centre, Singapore (NUHCS). Said AProf Lam, “Heart failure with preserved ejection fraction is common, triggers recurrent hospital admissions, has a high mortality and carries a high burden of healthcare costs. It is hoped that through renal denervation, this simple, one-time approach will reduce both mortality and heart failure readmissions.”

The open, randomised controlled clinical trial will be conducted in seven sites across Singapore, New Zealand and Australia with operational support by the Singapore Clinical Research Institute (SCRI). “This trial demonstrates the close partnership between the private-public sector, between doctors in Singapore and doctors in Australia and New Zealand and also the close collaboration in research operations between NUHS and SCRI”, said Associate Professor Teoh Yee Leong, CEO SCRI.

Outcomes in heart failure remain poor with more than 50% of patients dying within five years. While therapeutic advances have been achieved in heart failure where patients have enlarged hearts that pump weakly (heart failure with reduced ejection fraction), no such gains have occurred in cases with stiff hearts. The knowledge gained from this trial will help doctors develop better treatments for the group of patients suffering from stiff hearts (preserved ejection fraction). First enrolments of study subjects are expected in the first half this year.

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