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Relationship between duration of heart failure, patient characteristics, outcomes, and effect of therapy in PARADIGM‐HF
AIMS: Little is known about patient characteristics, outcomes, and the effect of treatment in relation to duration of heart failure (HF). We have investigated these questions in PARADIGM‐HF. The aim of the study was to compare patient characteristics, outcomes, and the effect of sacubitril/valsartan...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754973/ https://www.ncbi.nlm.nih.gov/pubmed/33078584 http://dx.doi.org/10.1002/ehf2.12972 |
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author | Yeoh, Su E. Dewan, Pooja Desai, Akshay S. Solomon, Scott D. Rouleau, Jean L. Lefkowitz, Marty Rizkala, Adel Swedberg, Karl Zile, Michael R. Jhund, Pardeep S. Packer, Milton McMurray, John J.V. |
author_facet | Yeoh, Su E. Dewan, Pooja Desai, Akshay S. Solomon, Scott D. Rouleau, Jean L. Lefkowitz, Marty Rizkala, Adel Swedberg, Karl Zile, Michael R. Jhund, Pardeep S. Packer, Milton McMurray, John J.V. |
author_sort | Yeoh, Su E. |
collection | PubMed |
description | AIMS: Little is known about patient characteristics, outcomes, and the effect of treatment in relation to duration of heart failure (HF). We have investigated these questions in PARADIGM‐HF. The aim of the study was to compare patient characteristics, outcomes, and the effect of sacubitril/valsartan, compared with enalapril, in relation to time from HF diagnosis in PARADIGM‐HF. METHODS AND RESULTS: HF duration was categorized as 0–1, >1–2, >2–5, and >5 years. Outcomes were adjusted for prognostic variables, including N‐terminal pro‐brain natriuretic peptide (NT‐proBNP). The primary endpoint was the composite of HF hospitalization or cardiovascular death. The number of patients in each group was as follows: 0–1 year, 2523 (30%); >1–2 years, 1178 (14%); >2–5 years, 2054 (24.5%); and >5 years, 2644 (31.5%). Patients with longer‐duration HF were older, more often male, and had worse New York Heart Association class and quality of life, more co‐morbidity, and higher troponin‐T but similar NT‐proBNP levels. The primary outcome rate (per 100 person‐years) increased with HF duration: 0–1 year, 8.4 [95% confidence interval (CI) 7.6–9.2]; >1–2 years, 11.2 (10.0–12.7); >2–5 years, 13.4 (12.4–14.6); and >5 years, 14.2 (13.2–15.2); P < 0.001. The hazard ratio was 1.26 (95% CI 1.07–1.48), 1.52 (1.33–1.74), and 1.53 (1.33–1.75), respectively, for >1–2, >2–5, and >5 years, compared with 0–1 year. The benefit of sacubitril/valsartan was consistent across HF duration for all outcomes, with the primary endpoint hazard ratio 0.80 (95% CI 0.67–0.97) for 0–1 year and 0.73 (0.63–0.84) in the >5 year group. For the primary outcome, the number needed to treat for >5 years was 18, compared with 29 for 0–1 year. CONCLUSIONS: Patients with longer‐duration HF had more co‐morbidity, worse quality of life, and higher rates of HF hospitalization and death. The benefit of a neprilysin inhibitor was consistent, irrespective of HF duration. Switching to sacubitril/valsartan had substantial benefits, even in patients with long‐standing HF. |
format | Online Article Text |
id | pubmed-7754973 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-77549732020-12-23 Relationship between duration of heart failure, patient characteristics, outcomes, and effect of therapy in PARADIGM‐HF Yeoh, Su E. Dewan, Pooja Desai, Akshay S. Solomon, Scott D. Rouleau, Jean L. Lefkowitz, Marty Rizkala, Adel Swedberg, Karl Zile, Michael R. Jhund, Pardeep S. Packer, Milton McMurray, John J.V. ESC Heart Fail Original Research Articles AIMS: Little is known about patient characteristics, outcomes, and the effect of treatment in relation to duration of heart failure (HF). We have investigated these questions in PARADIGM‐HF. The aim of the study was to compare patient characteristics, outcomes, and the effect of sacubitril/valsartan, compared with enalapril, in relation to time from HF diagnosis in PARADIGM‐HF. METHODS AND RESULTS: HF duration was categorized as 0–1, >1–2, >2–5, and >5 years. Outcomes were adjusted for prognostic variables, including N‐terminal pro‐brain natriuretic peptide (NT‐proBNP). The primary endpoint was the composite of HF hospitalization or cardiovascular death. The number of patients in each group was as follows: 0–1 year, 2523 (30%); >1–2 years, 1178 (14%); >2–5 years, 2054 (24.5%); and >5 years, 2644 (31.5%). Patients with longer‐duration HF were older, more often male, and had worse New York Heart Association class and quality of life, more co‐morbidity, and higher troponin‐T but similar NT‐proBNP levels. The primary outcome rate (per 100 person‐years) increased with HF duration: 0–1 year, 8.4 [95% confidence interval (CI) 7.6–9.2]; >1–2 years, 11.2 (10.0–12.7); >2–5 years, 13.4 (12.4–14.6); and >5 years, 14.2 (13.2–15.2); P < 0.001. The hazard ratio was 1.26 (95% CI 1.07–1.48), 1.52 (1.33–1.74), and 1.53 (1.33–1.75), respectively, for >1–2, >2–5, and >5 years, compared with 0–1 year. The benefit of sacubitril/valsartan was consistent across HF duration for all outcomes, with the primary endpoint hazard ratio 0.80 (95% CI 0.67–0.97) for 0–1 year and 0.73 (0.63–0.84) in the >5 year group. For the primary outcome, the number needed to treat for >5 years was 18, compared with 29 for 0–1 year. CONCLUSIONS: Patients with longer‐duration HF had more co‐morbidity, worse quality of life, and higher rates of HF hospitalization and death. The benefit of a neprilysin inhibitor was consistent, irrespective of HF duration. Switching to sacubitril/valsartan had substantial benefits, even in patients with long‐standing HF. John Wiley and Sons Inc. 2020-10-19 /pmc/articles/PMC7754973/ /pubmed/33078584 http://dx.doi.org/10.1002/ehf2.12972 Text en © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Articles Yeoh, Su E. Dewan, Pooja Desai, Akshay S. Solomon, Scott D. Rouleau, Jean L. Lefkowitz, Marty Rizkala, Adel Swedberg, Karl Zile, Michael R. Jhund, Pardeep S. Packer, Milton McMurray, John J.V. Relationship between duration of heart failure, patient characteristics, outcomes, and effect of therapy in PARADIGM‐HF |
title | Relationship between duration of heart failure, patient characteristics, outcomes, and effect of therapy in PARADIGM‐HF |
title_full | Relationship between duration of heart failure, patient characteristics, outcomes, and effect of therapy in PARADIGM‐HF |
title_fullStr | Relationship between duration of heart failure, patient characteristics, outcomes, and effect of therapy in PARADIGM‐HF |
title_full_unstemmed | Relationship between duration of heart failure, patient characteristics, outcomes, and effect of therapy in PARADIGM‐HF |
title_short | Relationship between duration of heart failure, patient characteristics, outcomes, and effect of therapy in PARADIGM‐HF |
title_sort | relationship between duration of heart failure, patient characteristics, outcomes, and effect of therapy in paradigm‐hf |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754973/ https://www.ncbi.nlm.nih.gov/pubmed/33078584 http://dx.doi.org/10.1002/ehf2.12972 |
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