Cardiology

CARE-HK registry shows limited overlap with DIAMOND trial eligibility in HF patients

Only 17.2% of real-world CARE-HK HF patients met DIAMOND eligibility, falling to 3.4% when excluding missing data. CARE-HK participants were older (median 71.8 vs 67.2 years), more often female, and had higher comorbidity and worse renal function. HFrEF patients in CARE-HK received higher use of ARNI, SGLT2i, and quadruple therapy than DIAMOND, yet guideline therapy uptake remained incomplete. These differences underscore limited direct applicability of DIAMOND efficacy estimates to routine HF populations. 1

ALLEVIATE-HF: ICM-based alerts with nurse-led diuretic protocols were safe but not efficacious for primary outcome

In 711 randomized HF patients, ICM-based high-risk alerts triggered centrally managed diuretic protocols without excess intervention-related serious adverse events (0.32%). The primary 60-day hierarchical composite did not differ (win ratio 0.79; P=0.06), a neutral result under the tested implementation. Over 17.3 months there were numerically more cardiovascular deaths or HF events in the intervention arm (HR 1.43; P=0.091). The strategy appears safe but not proven to improve short-term clinical outcomes with this centralized, nurse-facilitated model. 2

ICM monitoring in ALLEVIATE-HF found high arrhythmia incidence but no burden reduction with congestion management

Among 711 ambulatory HF patients, 3-year atrial fibrillation occurrence was 66.6%, with new-onset AF 25.4%. Arrhythmia rates during the 13-month randomized phase did not differ between ICM-guided congestion management and usual care. ICM-detected arrhythmias strongly predicted subsequent arrhythmia-directed interventions and higher hospitalization and HF event risks. Bradyarrhythmia was more common with EF ≥50%, whereas VT/VF clustered with EF <50%. 3