Heart failure & cardiomyopathiesMeta-analysis
Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure
- Prespecified pooled analysis of the PARADIGM-HF and PARAGON-HF randomised trials
Authors' conclusion
The therapeutic effects of sacubitril/valsartan, compared with a renin-angiotensin-aldosterone-system inhibitor alone, vary by LVEF with treatment benefits, particularly for heart failure hospitalization, that appear to extend to patients with heart failure and mildly reduced ejection fraction.
Study context
- Population
- Heart failure (HF) patients across the left ventricular ejection fraction (LVEF) spectrum (PARADIGM-HF LVEF ≤40%, n=8399; PARAGON-HF LVEF ≥45%, n=4796)
- Participants
- 13,195 patients · 2 RCTs
- Comparison
- Sacubitril/valsartan vs RAAS inhibitor alone across LVEF
- Outcome
- Time to first CV death or HF hospitalization
Pooled result
As reported in the abstract
First CV death or HF hospitalization, overall and by LVEF
Hazard ratio
0.84
95% CI 0.78–0.90
Sacubitril/valsartan vs RAAS inhibitor
HR 0.84 (95% CI 0.78–0.90)
- Effect modified by LVEF; benefit appeared present with EF primarily below the normal range
- P = 0.02
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| CV death | 0.84 (0.76–0.92) | |
| HF hospitalization | 0.84 (0.77–0.91) | |
| All-cause mortality | 0.88 (0.81–0.96) | |
| 0.512Hazard ratio (log scale) |
Total HF hospitalizations and CV death, by sex
- Effect modification by LVEF in both men and women; women derived benefit to higher EF
Original publication
Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure. Circulation. Published 17 November 2019. doi:10.1161/circulationaha.119.044586
Summarised from the published abstract; every number is checked against it