SLU Heart Failure Expert Pens Editorial for New England Journal of Medicine
ST. LOUIS – In patients experiencing a worsening of heart failure, the primary objective
of treatment should be the patient-centric goal of symptom relief, says the author
of an editorial in the current issue of the New England Journal of Medicine.
Paul J. Hauptman, M.D., a SLUCare cardiologist specializing in heart failure and professor of internal medicine
at Saint Louis University School of Medicine, looked at the results of the Trial of
Ularitide Efficacy and Safety in Acute Heart Failure (TRUE-AHF), which was designed
to evaluate the safety and efficacy of a novel synthetic compound “ularitide” administered
very soon after a patient presents with acute decompensated heart failure (ADHF).
ADHF is a sudden worsening of the signs and symptoms of heart failure, which typically
includes difficulty breathing (dyspnea), leg or feet swelling, and fatigue.
Hauptman’s editorial, “Disease Modification in Acute Decompensated Heart Failure,” was published online April 12 ahead of print publication in the New England Journal of Medicine.
Hauptman’s review of the TRUE-AHF trial looked at the two hypotheses being tested
– that a single infusion of ularitide would improve early clinical outcomes and that
a rapid treatment approach to exacerbation of heart failure improves longer-term survival.
“We can conclude that ularitide, like its predecessor nesiritide, has limited short-term
effects that wane after the discontinuation of treatment, which lessens the likelihood
that there is a constructive avenue for further development of natriuretic peptides,”
Hauptman wrote in his editorial. “It also appears that we do not have a mandate to
establish rapid-response teams for patients who present with acute decompensated heart
Hauptman notes the need for greater consensus on how to define the response to intervention
and to determine which patients are in greatest therapeutic need.
“Exacerbations of chronic disease reflect the chronic disease, not the hospitalizations
used to manage those exacerbations,” Hauptman wrote. “The search for improved understanding
of the pathophysiology of heart-failure decompensation continues, and so does the
search for better treatments.”
Hauptman has a background in clinical and outcomes research in heart failure. He has
been an investigator in multiple trials for more than 20 years. In 2014, Hauptman
was named the editor-in-chief of the Journal of Cardiac Failure. In 2016, Hauptman was named an inaugural Fellow of the Heart Failure Society of America
Established in 1836, Saint Louis University School of Medicine has the distinction
of awarding the first medical degree west of the Mississippi River. The school educates
physicians and biomedical scientists, conducts medical research, and provides health
care on a local, national and international level. Research at the school seeks new
cures and treatments in five key areas: infectious disease, liver disease, cancer,
heart/lung disease, and aging and brain disorders.