Rolofylline for Acute Heart Failure? Maybe Not

Declining renal function is common and a harbinger of poor outcome in patients with heart failure (HF). Research has suggested that compensatory responses mediated by adenosine contribute to this complication. Rolofylline is an adenosine A₁–receptor antagonist that relieved dyspnea and reduced renal dysfunction in previous studies.

In an industry-sponsored, phase III trial, investigators compared rolofylline with placebo in patients hospitalized with acute HF. All patients had impaired renal function (creatinine clearance, 20–80 mL/minute). The primary endpoint was patient-reported treatment success, defined as moderate or marked improvement in dyspnea; or treatment failure, defined as any of the following through day 7: death or HF readmiss…