Heart failure & cardiomyopathiesSecondary analysis
Angiotensin Receptor Neprilysin Inhibition and Cardiovascular Outcomes Across the Kidney Function Spectrum
- Secondary analysis of the PARAGON-HF randomised trial
- subgroup analysis by baseline estimated glomerular filtration rate (eGFR) and left ventricular ejection fraction (LVEF)
Authors' conclusion
In the PARAGON-HF trial, the benefits of sacubitril/valsartan to reduce the frequency of HF hospitalizations and cardiovascular death were most apparent in patients with lower baseline eGFR and lower ejection fraction.
Study context
- Population
- Chronic heart failure (HF) with LVEF ≥45%, by baseline kidney function1,955 (41%) with eGFR <60
- Participants
- 4,796 participants
- Comparison
- Sacubitril/valsartan vs valsartan
- Primary endpoint
- CV death and total HF hospitalizations, by baseline eGFR
Primary result
As reported in the abstract
Relative risk
0.69
95% CI 0.51–0.94
Sacubitril/valsartan vs Valsartan
RR 0.69 (95% CI 0.51–0.94)
- Greater reduction with lower baseline eGFR (P interaction, continuous eGFR)
- 0.07
Further findings
CV death, by baseline eGFR (subgroup)
- Nonlinear influence of eGFR on treatment effect; most pronounced with baseline eGFR <45 mL/min/1.73 m²
- HR: 0.65; 95% CI: 0.43-0.97
Primary outcome, by LVEF and eGFR (subgroup)
- Treatment effect most pronounced with LVEF ≤57% and eGFR ≤45 mL/min/1.73 m²
- HR: 0.66; 95% CI: 0.45-0.97
Original publication
Angiotensin Receptor Neprilysin Inhibition and Cardiovascular Outcomes Across the Kidney Function Spectrum. JACC Heart Fail. Published 20 November 2024. doi:10.1016/j.jchf.2024.08.022
Summarised from the published abstract; every number is checked against it