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Effect of sacubitri...
Effect of sacubitril/valsartan vs. enalapril on changes in heart failure therapies over time: the PARADIGM-HF trial
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Bhatt, A. S. (författare)
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Vaduganathan, M. (författare)
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Claggett, B. L. (författare)
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Liu, J. K. (författare)
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Packer, M. (författare)
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Desai, A. S. (författare)
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Lefkowitz, M. P. (författare)
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Rouleau, J. L. (författare)
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Shi, V. C. (författare)
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Zile, M. R. (författare)
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- Swedberg, Karl, 1944 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institute of Medicine
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Vardeny, O. (författare)
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McMurray, J. J. V. (författare)
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Solomon, S. D. (författare)
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(creator_code:org_t)
- 2021-06-21
- 2021
- Engelska.
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 23:9, s. 1518-1524
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Abstract
Ämnesord
Stäng
- 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 beta-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 beta-blocker and MRA use in patients randomized to sacubitril/valsartan vs. enalapril through 12-month follow-up. New initiations and discontinuations of beta-blocker and MRA were compared between treatment groups. Overall, 8398 (99.9%) had full medication and dose data at baseline. Baseline use of beta-blocker and MRA at any dose was 87% and 56%, respectively. Mean doses of beta-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 beta-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 beta-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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- beta-blockers
- Guideline-directed medical therapy
- Heart failure with
- reduced ejection fraction
- Mineralocorticoid receptor antagonists
- Sacubitril/valsartan
- mineralocorticoid receptor antagonists
- neprilysin inhibition
- guideline
- risk
- Cardiovascular System & Cardiology
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Till lärosätets databas
- Av författaren/redakt...
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Bhatt, A. S.
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Vaduganathan, M.
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Claggett, B. L.
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Liu, J. K.
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Packer, M.
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Desai, A. S.
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visa fler...
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Lefkowitz, M. P.
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Rouleau, J. L.
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Shi, V. C.
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Zile, M. R.
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Swedberg, Karl, ...
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Vardeny, O.
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McMurray, J. J. ...
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Solomon, S. D.
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visa färre...
- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Kardiologi
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European Journal ...
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Göteborgs universitet