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Effect of sacubitri...
Effect of sacubitril/valsartan on investigator-reported ventricular arrhythmias in PARADIGM-HF
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Curtain, J. P. (author)
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Jackson, A. M. (author)
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Shen, L. (author)
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Jhund, P. S. (author)
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Docherty, K. F. (author)
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Petrie, M. C. (author)
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Castagno, D. (author)
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Desai, A. S. (author)
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Rohde, L. E. (author)
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Lefkowitz, M. P. (author)
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Rouleau, J. L. (author)
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Zile, M. R. (author)
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Solomon, S. D. (author)
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- Swedberg, Karl, 1944 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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Packer, M. (author)
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McMurray, J. J. V. (author)
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(creator_code:org_t)
- 2022-01-19
- 2022
- English.
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In: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 24:3, s. 551-561
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https://onlinelibrar...
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https://gup.ub.gu.se...
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Abstract
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- Aims Sudden death is a leading cause of mortality in heart failure with reduced ejection fraction (HFrEF). In PARADIGM-HF, sacubitril/valsartan reduced the incidence of sudden death. The purpose of this post hoc study was to analyse the effect of sacubitril/valsartan, compared to enalapril, on the incidence of ventricular arrhythmias. Methods and results Adverse event reports related to ventricular arrhythmias were examined in PARADIGM-HF. The effect of randomized treatment on two arrhythmia outcomes was analysed: ventricular arrhythmias and the composite of a ventricular arrhythmia, implantable cardioverter defibrillator (ICD) shock or resuscitated cardiac arrest. The risk of death related to a ventricular arrhythmia was examined in time-updated models. The interaction between heart failure aetiology, or baseline ICD/cardiac resynchronization therapy-defibrillator (CRT-D) use, and the effect of sacubitril/valsartan was analysed. Of the 8399 participants, 333 (4.0%) reported a ventricular arrhythmia and 372 (4.4%) the composite arrhythmia outcome. Ventricular arrhythmias were associated with higher mortality. Compared with enalapril, sacubitril/valsartan reduced the risk of a ventricular arrhythmia (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.62-0.95; p = 0.015) and the composite arrhythmia outcome (HR 0.79, 95% CI 0.65-0.97; p = 0.025). The treatment effect was maintained after adjustment and accounting for the competing risk of death. Baseline ICD/CRT-D use did not modify the effect of sacubitril/valsartan, but aetiology did: HR in patients with an ischaemic aetiology 0.93 (95% CI 0.71-1.21) versus 0.53 (95% CI 0.37-0.78) in those without an ischaemic aetiology (p for interaction = 0.020). Conclusions Sacubitril/valsartan reduced the incidence of investigator-reported ventricular arrhythmias in patients with HFrEF. This effect may have been greater in patients with a non-ischaemic aetiology.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Neprilysin inhibitor
- Heart failure
- Ventricular tachyarrhythmia
- angiotensin-neprilysin inhibition
- heart-failure
- myocardial-infarction
- sudden-death
- enalapril
- tachycardia
- prevalence
- lcz696
- risk
- Cardiovascular System & Cardiology
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Curtain, J. P.
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Jackson, A. M.
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Shen, L.
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Jhund, P. S.
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Docherty, K. F.
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Petrie, M. C.
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show more...
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Castagno, D.
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Desai, A. S.
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Rohde, L. E.
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Lefkowitz, M. P.
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Rouleau, J. L.
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Zile, M. R.
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Solomon, S. D.
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Swedberg, Karl, ...
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Packer, M.
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McMurray, J. J. ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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European Journal ...
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University of Gothenburg