New trial highlights need for lifelong medication for dilated cardiomyopathy

Dilated cardiomyopathy – a condition where the heart is enlarged and function is impaired usually due to a viral or genetic cause, is one of the leading causes of heart failure in the UK and the most common reason for people needing a heart transplant.

However, some patients will make a full recovery, showing no symptoms and having normal heart function.

For those patients, a new study led by a team at Royal Brompton Hospital and Imperial College London has sought to answer a question that they often ask: “Now that I’ve recovered, do I need to take medication forever?”

The TRED-HF study, presented at the American Heart Association Scientific Sessions earlier in Chicago, found that individuals should remain on heart failure drugs indefinitely, even if their ventricular function has improved.

The patients are frequently young, so the prospect of having to take a number of medicines for decades – with potential side effects – can be daunting.

The randomised trial followed 51 patients, 25 of whom had a gradual withdrawal of their heart failure medication – in some cases up to four different drugs – and 26 who continued their treatment unchanged. Participants were of a broad age range and about two-thirds were men.

Researchers found that 11 of the 25 who had their treatment withdrawn – or 44 per cent – relapsed within eight weeks of being taken off the medications. However, it was noted that the relapse rate would probably have been even greater if these patients had been followed up for a longer period.

In contrast, none of the 26 patients who continued their treatment relapsed.

Brian Halliday, clinical research fellow at Royal Brompton and Imperial College said: “Improvement in a patient’s ventricular function seems to represent remission rather than a permanent cure for many.

“So, withdrawal of therapy should not usually be advised – at least until we have a better understanding of specific therapies that may be able to be reduced and the importance of the different components of therapy.

“This was a pilot study and clearly more research in this area is needed to define permanent recovery from dilated cardiomyopathy.

“But for now, we need to say to our patients that they should stay on their medications until further research allows us to advise them otherwise.”

Importantly, patients in the study were closely monitored and were quickly put back on medications at early signs of relapse. Ventricular function was typically restored soon after and there were no unplanned hospital admissions for heart failure as a result.

Dr Sanjay Prasad, consultant cardiologist and the trial’s principal investigator, said: “It was a team effort bringing together non-invasive cardiology, genetics, advanced imaging, research and development, patient groups and our colleagues in other hospitals. From the response, the study is already having impact on how patients are managed.’’

For more information on dilated cardiomyopathy, visit the NHS website, or read about TRED-HF in The Lancet.