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VIDEO: PARADIGM-HF analyses demonstrate clinical benefit regardless of patient stability, background therapy
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CHICAGO — In this video exclusive, Scott D. Solomon, MD, discusses new post-hoc analyses of the PARADIGM-HF trial presented at the American College of Cardiology Scientific Session demonstrating reduced CV death or hospitalization for HF after treatment with sacubitril and valsartan in patients with HF with reduced ejection fraction regardless of prior HF hospital admissions or background therapy.
PARADIGM-HF compared sacubitril/valsartan (Entresto, Novartis) with the ACE inhibitor enalapril.
“We’ve been asked a lot of questions about the data from PARADIGM-HF and one of them has been, ‘If my patient is doing well and is stable, should they be switched from the ACE inhibitor or the [angiotensin receptor blocker] that they’re on now to sacubitril/valsartan?’” said Solomon, director of noninvasive surgery at Brigham and Women’s Hospital and professor at Harvard Medical School. “So we looked at this by looking at the most stable patients in PARADIGM-HF.”
The analysis determined that sacubitril/valsartan benefited patients who were clinically stable and those who were the least stable, with HF hospitalization within the previous 3 months. In both groups, sacubitril/valsartan was associated with at least a 20% greater reduction in CV death or HF hospitalization compared with enalapril.
In a second analysis, sacubitril/valsartan yielded consistent benefits in patients with HFrEF and reduced the risk for CV death or HF hospitalization by approximately 20% compared with enalapril, regardless of background therapy. The effects were observed among patients taking higher and lower doses of beta-blockers, those taking mineralocorticoid receptor antagonists and those with or without an ICD or CRT-D.