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Effect of sacubitril/valsartan vs. enalapril on changes in heart failure therapies over time: the PARADIGM‐HF trial
AIMS: Sacubitril/valsartan improves morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Whether initiation of sacubitril/valsartan limits the use and dosing of other elements of guideline‐directed medical therapy for HFrEF is unknown. We examined the effects...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons, Ltd.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291580/ https://www.ncbi.nlm.nih.gov/pubmed/34101308 http://dx.doi.org/10.1002/ejhf.2259 |
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author | Bhatt, Ankeet S. Vaduganathan, Muthiah Claggett, Brian L. Liu, Jiankang Packer, Milton Desai, Akshay S. Lefkowitz, Martin P. Rouleau, Jean L. Shi, Victor C. Zile, Michael R. Swedberg, Karl Vardeny, Orly McMurray, John J.V. Solomon, Scott D. |
author_facet | Bhatt, Ankeet S. Vaduganathan, Muthiah Claggett, Brian L. Liu, Jiankang Packer, Milton Desai, Akshay S. Lefkowitz, Martin P. Rouleau, Jean L. Shi, Victor C. Zile, Michael R. Swedberg, Karl Vardeny, Orly McMurray, John J.V. Solomon, Scott D. |
author_sort | Bhatt, Ankeet S. |
collection | PubMed |
description | AIMS: Sacubitril/valsartan improves morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Whether initiation of sacubitril/valsartan limits the use and dosing of other elements of guideline‐directed medical therapy for HFrEF is unknown. We examined the effects of sacubitril/valsartan, compared with enalapril, on β‐blocker and mineralocorticoid receptor antagonist (MRA) use and dosing in a large randomized clinical trial. METHODS AND RESULTS: Patients with full data on medication use were included. We examined β‐blocker and MRA use in patients randomized to sacubitril/valsartan vs. enalapril through 12‐month follow‐up. New initiations and discontinuations of β‐blocker and MRA were compared between treatment groups. Overall, 8398 (99.9%) had full medication and dose data at baseline. Baseline use of β‐blocker and MRA at any dose was 87% and 56%, respectively. Mean doses of β‐blocker and MRA were similar between treatment groups at baseline and at 6‐month and 12‐month follow‐up. New initiations through 12‐month follow‐up were infrequent and similar in the sacubitril/valsartan and enalapril groups for β‐blockers [37 (9.0%) vs. 42 (10.2%), P = 0.56] and MRA [127 (7.6%) vs. 143 (9.2%), P = 0.10]. Among patients on MRA therapy at baseline, there were fewer MRA discontinuations in patients on sacubitril/valsartan as compared with enalapril at 12 months [125 (6.2%) vs. 187 (9.0%), P = 0.001]. Discontinuations of β‐blockers were not significantly different between groups in follow‐up (2.2% vs. 2.6%, P = 0.26). CONCLUSIONS: Initiation of sacubitril/valsartan, even when titrated to target dose, did not appear to lead to greater discontinuation or dose down‐titration of other key guideline‐directed medical therapies, and was associated with fewer discontinuations of MRA. Use of sacubitril/valsartan (when compared with enalapril) may promote sustained MRA use in follow‐up. |
format | Online Article Text |
id | pubmed-9291580 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley & Sons, Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92915802022-07-20 Effect of sacubitril/valsartan vs. enalapril on changes in heart failure therapies over time: the PARADIGM‐HF trial Bhatt, Ankeet S. Vaduganathan, Muthiah Claggett, Brian L. Liu, Jiankang Packer, Milton Desai, Akshay S. Lefkowitz, Martin P. Rouleau, Jean L. Shi, Victor C. Zile, Michael R. Swedberg, Karl Vardeny, Orly McMurray, John J.V. Solomon, Scott D. Eur J Heart Fail Dug Titration and Adherence AIMS: Sacubitril/valsartan improves morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Whether initiation of sacubitril/valsartan limits the use and dosing of other elements of guideline‐directed medical therapy for HFrEF is unknown. We examined the effects of sacubitril/valsartan, compared with enalapril, on β‐blocker and mineralocorticoid receptor antagonist (MRA) use and dosing in a large randomized clinical trial. METHODS AND RESULTS: Patients with full data on medication use were included. We examined β‐blocker and MRA use in patients randomized to sacubitril/valsartan vs. enalapril through 12‐month follow‐up. New initiations and discontinuations of β‐blocker and MRA were compared between treatment groups. Overall, 8398 (99.9%) had full medication and dose data at baseline. Baseline use of β‐blocker and MRA at any dose was 87% and 56%, respectively. Mean doses of β‐blocker and MRA were similar between treatment groups at baseline and at 6‐month and 12‐month follow‐up. New initiations through 12‐month follow‐up were infrequent and similar in the sacubitril/valsartan and enalapril groups for β‐blockers [37 (9.0%) vs. 42 (10.2%), P = 0.56] and MRA [127 (7.6%) vs. 143 (9.2%), P = 0.10]. Among patients on MRA therapy at baseline, there were fewer MRA discontinuations in patients on sacubitril/valsartan as compared with enalapril at 12 months [125 (6.2%) vs. 187 (9.0%), P = 0.001]. Discontinuations of β‐blockers were not significantly different between groups in follow‐up (2.2% vs. 2.6%, P = 0.26). CONCLUSIONS: Initiation of sacubitril/valsartan, even when titrated to target dose, did not appear to lead to greater discontinuation or dose down‐titration of other key guideline‐directed medical therapies, and was associated with fewer discontinuations of MRA. Use of sacubitril/valsartan (when compared with enalapril) may promote sustained MRA use in follow‐up. John Wiley & Sons, Ltd. 2021-06-21 2021-09 /pmc/articles/PMC9291580/ /pubmed/34101308 http://dx.doi.org/10.1002/ejhf.2259 Text en © 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Dug Titration and Adherence Bhatt, Ankeet S. Vaduganathan, Muthiah Claggett, Brian L. Liu, Jiankang Packer, Milton Desai, Akshay S. Lefkowitz, Martin P. Rouleau, Jean L. Shi, Victor C. Zile, Michael R. Swedberg, Karl Vardeny, Orly McMurray, John J.V. Solomon, Scott D. Effect of sacubitril/valsartan vs. enalapril on changes in heart failure therapies over time: the PARADIGM‐HF trial |
title | Effect of sacubitril/valsartan vs. enalapril on changes in heart failure therapies over time: the PARADIGM‐HF trial |
title_full | Effect of sacubitril/valsartan vs. enalapril on changes in heart failure therapies over time: the PARADIGM‐HF trial |
title_fullStr | Effect of sacubitril/valsartan vs. enalapril on changes in heart failure therapies over time: the PARADIGM‐HF trial |
title_full_unstemmed | Effect of sacubitril/valsartan vs. enalapril on changes in heart failure therapies over time: the PARADIGM‐HF trial |
title_short | Effect of sacubitril/valsartan vs. enalapril on changes in heart failure therapies over time: the PARADIGM‐HF trial |
title_sort | effect of sacubitril/valsartan vs. enalapril on changes in heart failure therapies over time: the paradigm‐hf trial |
topic | Dug Titration and Adherence |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291580/ https://www.ncbi.nlm.nih.gov/pubmed/34101308 http://dx.doi.org/10.1002/ejhf.2259 |
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