TRED-HF: safe to withdraw HF treatment in recovered DCM?


Take Home Messages
  • Patients with dilated cardiomyopathy (DCM) who are asymptomatic and have recovered left ventricular (LV) function frequently question if they need to continue their heart failure (HF) medications, however little is known about the safety of treatment cessation in this setting.
  • The TRED-HF trial examined the effect of withdrawal of HF medications in patients diagnosed with DCM who had recovered their LV function.
  • The study found discontinuation of pharmacological therapy in patients with recovered DCM led to relapse of HF.
  • Further studies are warranted to delineate predictors of relapse in this patient population which may help to identify those individuals in whom treatment withdrawal can be safely achieved.

Dilated cardiomyopathy (DCM) is a disease in which the chambers of the heart enlarge, characterised by left ventricular (LV) dilatation and systolic dysfunction. Many of these patients show an improvement in LV function and clinical outcomes during the course of their disease (1), as has also been observed in other cases of heart failure with reduced ejection fraction (HFrEF) following initial presentation (2-4). Anecdotally, such patients may at times be disinclined to taking medications due to various reasons such as  poor compliance, side-effects, hypotension and pregnancy planning. The logical question then arises for those individuals with DCM whose symptoms and LV function have subsequently recovered on pharmacological therapy, is it necessary to continue prognostic medications in the long-term?