Highlights of the Annual Scientific Meeting of the Heart Failure Society of America 2016
Authors: Mandeep R. Mehra, JoAnn Lindenfeld
Journal: Circulation (2016)

T he 20th annual meeting of the Heart Failure Society of America (HFSA) (September 17-20, 2016), held in Orlando, Florida, assembled multidisciplinary teams of clinicians and scientists for a thrilling journey of high-quality patient-centered care, an emerging theme of implementation science and trial interpretation.Two trials of the vasopressin antagonist Tolvaptan in the setting of hospitalized heart failure (HF), and 2 separate applications of palliative care in advanced stage HF, debuted at the meeting.The aquaretic Tolvaptan was studied in the TACTICS (Targeting Acute Congestion With Tolvaptan in Congestive HF Study) and SECRET of CHF (Study to Evaluate Challenging Responses to Therapy in Congestive HF) trials.Neither of these trials met their efficacy end points, leaving the only potential indication in HF as severe hyponatremia associated with cognitive deficit.The important topic of palliative care in HF was addressed in 2 studies.The PAL-HF (Palliative Care in HF) trial from Duke University used a nurse practitioner-based intervention to study physical and psychosocial symptom relief, attention to spiritual concerns, and advanced care planning in those at high risk of 6-month mortality and morbidity.The SWAP-HF study (Social Worker-Aided Palliative Care Intervention in High risk Patients with HF) from the Brigham and Women's Hospital investigated bridging of care by using a specially-trained social worker to catalyze clinician-led efforts to improve prognostic understanding, elicit advanced care preferences, and adapt care plans in patients at high risk for early mortality.The palliative care team approach must focus on universal application to less specialized care teams.An analysis from the TOPCAT study (Treatment of Preserved Cardiac Function HF with an Aldosterone Antagonist) demonstrated that, among Russian patients randomized to the spironolactone arm who reported taking their drug as prescribed, a third failed to harbor detectable blood levels of canrenone, a spironolactone metabolite.These findings suggest that interpretation of the TOPCAT results may need to focus on the observed findings among the North America-enrolled patients, a subset in which the efficacy of spironolactone was suggested compared with placebo for HF with preserved ejection fraction.The HFSA Lifetime Achievement Award honored Marc A. Pfeffer, MD, PhD, for scientific explorations spanning the bench-to-bedside journey into the concept of postinfarction left ventricular remodeling and its attenuation with neurohormonal antagonism in ongoing clinical trial leadership.The first Tom Force Late-Breaking Basic and Translational Science lecture was presented by Javid Moslehi, MD, on fulminant myocarditis and myositis in the setting of a combination of ipilimumab and nivolumab, currently approved therapies for metastatic malignancy, including melanoma.This fatal, T-cell-driven reaction is a novel but rare attribute of immune checkpoint blockade.This exciting HFSA meeting demonstrated the society's renewed focus on forging implementation science, fostering global relationships, and engaging members, young and old, from all disciplines focused on tackling the pandemic of HF.