01 Sep 2025



Hot Line ESC Congress 2025

Underserved populations experience benefits from creative solutions investigated in Hot Line 9.

Professor Renato Lopes (Duke University Medical Center – Durham, USA) presented the first randomised trial evidence to support a pharmacological treatment for Chagas cardiomyopathy, which occurs in 30–40% of patients with Chagas disease. The PARACHUTE-HF trial, conducted in Brazil, Argentina, Mexico and Colombia, randomised 922 patients positive for Trypanosoma cruzi infection, with LVEF ≤40%, NYHA class ≥II symptoms and elevated NT-proBNP to sacubitril/valsartan (target of 200 mg twice daily) or enalapril (target of 10 mg twice daily). The primary endpoint was a hierarchical composite outcome of cardiovascular (CV) death, first heart failure (HF) hospitalisation and the relative change from baseline to week 12 in NT-proBNP. Sacubitril/valsartan was associated with a 52% higher likelihood of a better primary outcome vs. enalapril (stratified unmatched win ratio 1.52; 95% CI 1.28 to 1.82; p<0.001). Over a median of 25 months’ follow-up, rates were similar for sacubitril/valsartan vs. enalapril for CV death and first HF hospitalisation. The significant difference in the primary outcome was predominantly driven by a 32% reduction in NT-proBNP levels at week 12. Prof. Lopes concluded: “PARACHUTE-HF shows that much-needed studies to better characterise chronic Chagas cardiomyopathy and to define the benefit/risk of new therapies in this condition are possible.”

Next, Doctor Robin Hofmann (Karolinska Institute – Stockholm, Sweden) presented results from HELP-MI SWEDEHEART, a real-world crossover study in 18,466 individuals that assessed whether systematic Helicobacter pylori screening could reduce upper gastrointestinal bleeding and improve outcomes after myocardial infarction (MI). After a median follow-up of 1.9 years, there was no significant difference in upper gastrointestinal bleeding, which occurred in 4.1% of patients in the H. pylori screening group and 4.6% in the control group (rate ratio 0.90; 95% CI 0.77 to 1.05; p=0.18). Predefined subgroup analyses indicated lower risk ratios for upper gastrointestinal bleeding with screening in patients with anaemia. Concluding, Dr. Hofmann said: “Among unselected patients with acute MI in Sweden – where H. pylori infection rates appeared relatively low – routine screening did not significantly reduce the risk of upper gastrointestinal bleeding. However, our results cannot rule out a clinically relevant benefit of H. pylori screening in populations with higher infection prevalence and in subgroups at higher risk of bleeding indicated by concomitant anaemia.”

Results on the safety of implanting reconditioned pacemakers were presented by Doctor Thomas Crawford (University of Michigan – Ann Arbor, USA) from Project My Heart Your Heart. He described how a comprehensive cleaning and testing protocol was developed for used devices and FDA approval gained for export to countries whose governments provided permission. A trial was then conducted in Kenya, Mexico, Mozambique, Nigeria, Paraguay, Sierra Leone and Venezuela, in 306 patients randomised to receive a reconditioned pacemaker or a new pacemaker. The primary finding was that the 12-month procedure-related infection rate was noninferior: 1.6% with reconditioned pacemakers and 3.1% with new pacemakers. There were no device malfunctions in either group. Dr. Crawford concluded: “The work of Project My Heart Your Heart serves as a blueprint that can be replicated by other organisations to enable wider pacemaker reuse. We would like to expand into reconditioned implantable cardioverter-defibrillator devices, which are even more expensive and out of reach for many patients across the world.”

The session ended with the IMPACT-BP trial, presented by Doctor Thomas Gaziano (Mass General Brigham and Harvard Medical School – Boston, USA), which assessed the effectiveness of home-based, technology-supported interventions to improve blood pressure (BP) control in low-resourced rural South Africa. In total, 744 patients with uncontrolled hypertension were randomised to one of three strategies: 1) standard clinic-based management; 2) home-based BP self-monitoring supported by the provision of BP machines, community health workers (CHWs) who conducted home visits for data collection and medication delivery, and remote nurse-led care assisted by a mobile application with decision support; and 3) an enhanced CHW arm in which BP machines included cellular technology to transmit BP readings automatically to the mobile application. Compared with standard care, mean systolic BP at 6 months was lower in the CHW group (–7.9 mmHg; p<0.001) and the enhanced CHW group (–9.1 mmHg; p<0.001). In the standard-care group, hypertension control at 6 months was 57.6% compared with 76.9% in the CHW group and 82.8% in the enhanced CHW group. Retention in care remained more than 95% with both interventions, with patients reported to have enjoyed managing their own hypertension. Investigator, Professor Nombulelo Magula (University of KwaZulu-Natal and the KwaZulu-Natal Provincial Department of Health – South Africa) concluded: “Achieving hypertension control in over 80% of people in a predominantly Black African community in rural South Africa is a clear example that equitable health care access can be achieved in disadvantaged communities. Similar models of care that address structural barriers could be considered to improve hypertension control in other remote and resource-limited settings.”