The Exchange

Commentary and Observations from
the Medical Front Lines

No Difference in Outcomes and Treatment No Matter the Etiology—Analysis from PARADIGM-HF Trial

No Difference in Outcomes and Treatment No Matter the Etiology—Analysis from PARADIGM-HF Trial

Heart failure (HF) is a complicated disease state with multiple, staged therapies. Over the last couple of years, addition of a sacubitril/valsartan combination has been shown to improve HF symptoms and reduce hospitalizations. This improvement has been a welcome addition to the multi-faceted approach for those with HF with reduced ejection fraction (HFrEF), and has been added to the 2017 updated American Heart Association/American College of Cardiology regimen for treatment of HF.

Because the disease has multiple etiologies, the PARADIGM-HF trial was conducted to analyze the outcomes and effects of sacubitril/valsartan use based on the etiology of the HF. Of the 8399 patients studied, 60% (5036) had an ischemic etiology while the remaining 40% (1595) had a variety of non-ischemic conditions, such as hypertension and other diseases (viral, infectious, alcoholic, valvular, diabetes, and idiopathic). The findings suggest that there is no difference in outcomes and effects when using sacubitril/valsartan, regardless of the type of HFrEF the subjects had; In other words, the medication proved to be effective regardless of the etiology. The study’s primary end points evaluated hospitalizations and death from any cause; the results make the drug favored over enalapril for the treatment of HFrEF.

The bottom line for primary care practitioners and those treating HFrEF is clear: when caring for patients with HFrEF and a New York Heart Association Class II-IV, the use of sacubitril/valsartan will improve outcomes and efficacy and should be used as part of the normal regimen. Physician assistants and nurse practitioners would benefit from keeping up with the current literature to ensure the best outcomes for this patient population.

  • Balmforth C, Simpson J, Shen L, et al. Outcomes and effect of treatment according to etiology in HFrEF: an analysis of PARADIGM-HF. JACC Heart Fail. 2019;7:457-465.

Share this page:

Filed under: Cardiometabolic

Development Widget