Heart failure & cardiomyopathiesSecondary analysis
Cardiovascular-Kidney-Metabolic Overlap in Heart Failure with Preserved Ejection Fraction: Cardiac Structure and Function, Clinical Outcomes, and Response to Sacubitril/Valsartan in PARAGON-HF
- Secondary analysis of the PARAGON-HF randomised trial
- post-hoc analysis
Authors' conclusion
Cardiovascular-kidney-metabolic multimorbidity was common in PARAGON-HF and associated with adverse changes in cardiac structure and function and with a stepwise increase in risk of clinical outcomes. Treatment effects of sacubitril/valsartan were consistent irrespective of CKM burden.
Study context
- Population
- Patients with HFpEF in PARAGON-HF, by cardiovascular-kidney-metabolic (CKM) multimorbidity (atherosclerotic CVD, CKD, T2DM)
- Comparison
- Sacubitril/valsartan vs valsartan, by number of CKM conditions
- Primary endpoint
- Composite of:
- Total HF hospitalizations
- CV death
Primary result
As reported in the abstract
Total HF hospitalizations or CV death, by CKM conditions; sacubitril/valsartan effect
Rate ratio
3.06
95% CI 2.33–4.03
By group
Three CKM conditions vs HF alone
rate ratio 3.06 (95% CI 2.33–4.03)
- Sacubitril/valsartan treatment effect consistent irrespective of number of CKM conditions (interaction P)
- P for interaction = 0.75
Secondary outcomes
CV death, total heart failure (HF) hospitalizations, composite kidney endpoint: sacubitril/valsartan effect by CKM conditions
- CV death: consistent treatment effect
- P for interaction = 0.82
- Total HF hospitalizations: consistent treatment effect
- P for interaction = 0.67
- Composite kidney endpoint: consistent treatment effect
- P for interaction = 0.99
Cardiac structure and function
- CKM multimorbidity associated with higher septal and posterior wall thickness, lower global longitudinal strain, higher E/e' and worse RV function
Original publication
Cardiovascular-Kidney-Metabolic Overlap in Heart Failure with Preserved Ejection Fraction: Cardiac Structure and Function, Clinical Outcomes, and Response to Sacubitril/Valsartan in PARAGON-HF. Eur J Heart Fail. Published 26 June 2024. doi:10.1002/ejhf.3304
Summarised from the published abstract; every number is checked against it