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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAliskiren in addition to standard therapy does not reduce cardiovascular death or heart failure (HF) rehospitalization in patients hospitalized for HF with reduced left ventricular ejection fraction. This article presents data from the Six Months Efficacy and Safety of Aliskiren Therapy on Top of Standard Therapy, on Morbidity and Mortality in Patients With Acute Decompensated Heart Failure trial [ASTRONAUT; Gheorghiade M et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAliskiren in addition to standard therapy does not reduce cardiovascular (CV) death or heart failure (HF) rehospitalization in patients hospitalized for HF with reduced left ventricular ejection fraction (LVEF). Mihai Gheorghiade, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, presented data from the Six Months Efficacy and Safety of Aliskiren Therapy on Top of Standard Therapy, on Morbidity and Mortality in Patients With Acute Decompensated Heart Failure trial [ASTRONAUT; Gheorghiade M et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDespite the availability of several evidenced-based therapies for the treatment of patients hospitalized with HF, postdischarge mortality is as high as 14% and rehospitalization within 60 to 90 days is \u223c30% [Gheorghiade M et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2006]. The ASTRONAUT trial tested the hypothesis that the direct renin inhibitor, aliskiren, may improve postdischarge outcomes for patients hospitalized with HF when initiated during hospitalization and continued post discharge [Gheorghiade M et al. \u003Cem\u003EEur J Heart Fail\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the international Phase 3, double-blind, placebo-controlled ASTRONAUT trial, 1639 patients hospitalized with HF were randomized to receive either 150 mg (increased to 300 mg as tolerated) of aliskiren or placebo daily along with standard therapy [Gheorghiade M et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2013]. Patients were eligible if they had an LVEF \u226440%, B-type natriuretic peptide (BNP) \u2265400 pg\/mL or N-terminal pro-BNP \u22651600 pg\/mL at admission, and a systolic blood pressure \u2265110 mm Hg for at least 6 hours.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe study drug was continued for a median 11.3 months after discharge, and 1615 patients were included in the final efficacy analysis cohort. The primary endpoint was CV death or rehospitalization for HF within 6 months. CV death or rehospitalization for HF within 12 months was the key secondary endpoint.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ENo significant difference was observed between the aliskiren and placebo treatment groups for the primary endpoint of CV death or HF rehospitalization within 6 months (24.9% vs 26.5%; HR, 0.92; 95% CI, 0.76 to 1.12; p=0.41). In addition, no significant difference was observed for the key secondary endpoint of CV death or rehospitalization for HF within 12 months in the patients receiving aliskiren compared with those receiving placebo (35.0% vs 37.3%; HR, 93; 95% CI, 0.79 to 1.09; p=0.36).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThere was a significant treatment interaction for all-cause mortality dependent upon the presence of diabetes. Specifically, patients with diabetes receiving aliskiren had a significantly higher rate of all-cause mortality (HR, 1.64; 95% CI, 1.15 to 2.33) within 12 months of randomization compared with patients without diabetes (HR, 0.69; 95% CI, 0.50 to 0.94; p for interaction \u0026lt;0.001). There was a similar treatment interaction for CV death or rehospitalization for HF within 12 months with diabetic patients receiving aliskiren experiencing a higher rate of CV death or HF rehospitalization (HR, 1.16; 95% CI, 0.91 to 1.47) compared with patients without diabetes (HR, 0.80; 95% CI, 0.64 to 0.99; p for interaction=0.03). Although this interaction was statistically significant suggesting heterogeneity in the impact of aliskiren versus placebo among diabetic and nondiabetic subjects for all-cause mortality and CV death\/HF rehospitalization, this finding must be interpreted cautiously given the inherent statistical limitations.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe rates of hyperkalemia, renal impairment or renal failure, and hypotension were all more commonly observed in subjects receiving aliskiren versus placebo (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EDr. Gheorghiade concluded that the data from the ASTRONAUT trial demonstrate that when added to contemporary medical therapy for patients with systolic dysfunction hospitalized for HF, there was no clinical benefit to the addition of aliskiren. The impact of aliskiren among different patient populations, particularly the tendency toward worse outcomes in patients with diabetes, who are hospitalized for HF warrants further study.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13145\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13145\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13145\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003ESummary of Adverse Events by Treatment Group\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/2\/26\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the American College of Cardiology presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1936290138\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the American College of Cardiology presenting faculty who generously gave their time to ensure the accuracy 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