Receive heart surgery, then decide when to start new medications

Back to Heart Failure Due to Coronary Artery Disease trials

What is this trial?

This study is testing the right time to start two heart medications—an ARNI (a blood pressure and heart medication) and an SGLT2 inhibitor—in people whose hearts have been weakened by valve disease or blocked arteries and who have just had surgery or a procedure to fix the underlying problem. The trial compares two approaches: starting these medications immediately after the procedure, or waiting 6 months to see if the heart recovers naturally before beginning treatment.

Current guidelines recommend starting heart medications right away after surgery, but most of that guidance comes from studies of people with permanent heart damage. When the root cause of heart weakness is actually fixed by surgery—like opening a blocked artery or replacing a bad valve—the heart may recover on its own. This trial exists to find out whether starting this medication immediately is really necessary, or whether waiting and watching for recovery first might spare some patients from unnecessary medications and potential side effects.

Do you qualify?

You likely qualify if…

you are at least 18 years old
you have had a weakened heart with ejection fraction of 40% or lower before undergoing surgery
you have had a successful surgical or procedural correction of your heart problem (valve surgery, bypass surgery, or angioplasty with stent placement) within the past 10 days to 3 months
you are stable after surgery with normal blood pressure, heart rate, and no signs of fluid buildup
you can tolerate the two study medications (or have stopped them for 1 week if you were taking them before)

You likely don't qualify if…

you have a history of dangerous irregular heartbeats (sustained ventricular tachycardia or fibrillation)
your surgery did not completely fix the underlying problem, such as residual heart valve leakage or incomplete opening of blocked arteries
you have severely reduced kidney function with an eGFR below 30
you have type 1 diabetes or a history of diabetic ketoacidosis, or you cannot tolerate either of the study medications due to low blood pressure or other serious side effects
you have uncontrolled high blood pressure above 160 mmHg despite medication, or you are planning to become pregnant during the study

What participation looks like

You will be randomly assigned to one of two groups after your surgery. One group will start the two heart medications right away, while the other group will wait 6 months without these medications to see if your heart recovers naturally—though if your condition worsens, you can start them sooner. Either way, you will have follow-up visits and heart imaging over 12 months to measure your heart function and monitor how you're doing. The study team will track your health, symptoms, and blood work throughout this period.

When to start heart medications after heart surgery

What is this trial?

Do you qualify?

What participation looks like

Trial locations(4 sites)