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Heart failure & cardiomyopathiesSecondary analysis

Effects of Sacubitril/Valsartan According to Background Beta-Blocker Therapy in Patients with Heart Failure and Reduced Ejection Fraction: Insights from PARADIGM-HF

Eur J Heart FailPublished

  • Secondary analysis of the PARADIGM-HF randomised trial
  • subgroup analysis by background beta-blocker use
Read the original article ↗

Authors' conclusion

Sacubitril/valsartan may be more effective than enalapril in reducing the risk of death in patients not treated with a beta-blocker compared to those treated with a beta-blocker, but is effective regardless of beta-blocker use.

Study context

Population
Patients with HFrEF enrolled in PARADIGM-HF, taking or not taking a beta-blocker7,811 on beta-blocker, 588 not · taking 7,811 · or not taking 588
Participants
8,399 patients
Comparison
Sacubitril/valsartan vs enalapril, by background beta-blocker use
Primary endpoint
Time to first HF hospitalization or CV death

Primary result

As reported in the abstract

HF hospitalization or CV death, by beta-blocker use
Sacubitril/valsartan vs EnalaprilHazard ratio (95% CI)
no beta-blocker subgroup
0.61(0.45–0.82)
beta-blocker subgroup
0.82(0.75–0.90)

Further findings

CV death, by background beta-blocker use (subgroup)

Sacubitril/valsartan vs enalapril, no beta-blocker: HR
0.47 (0.32-0.69) (95% CI)
Sacubitril/valsartan vs enalapril, beta-blocker: HR
0.84 (0.75-0.95) (95% CI)
  • p-interaction <0.01

HF hospitalization, by background beta-blocker use (subgroup)

Sacubitril/valsartan vs enalapril, no beta-blocker: HR
0.76 (0.51-1.12) (95% CI)
Sacubitril/valsartan vs enalapril, beta-blocker: HR
0.80 (0.71-0.90) (95% CI)
  • p-interaction = 0.73

All-cause death, by background beta-blocker use (subgroup)

Sacubitril/valsartan vs enalapril, no beta-blocker: HR
0.50 (0.36-0.71) (95% CI)
Sacubitril/valsartan vs enalapril, beta-blocker: HR
0.89 (0.80-0.99) (95% CI)
  • p-interaction <0.01

Safety

Safety outcomes, by beta-blocker use

Safety outcomes of sacubitril/valsartan vs enalapril did not differ by background beta-blocker use

Original publication

Effects of Sacubitril/Valsartan According to Background Beta-Blocker Therapy in Patients with Heart Failure and Reduced Ejection Fraction: Insights from PARADIGM-HF. Eur J Heart Fail. Published 19 November 2024. doi:10.1002/ejhf.3515
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Summarised from the published abstract; every number is checked against it