Ankeet S. Bhatt, MD @BrighamCVFellows @mvaduganathan @UoGHeartFailure #HeartFailure #Cardiology #Research Changes In...

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Ankeet S. Bhatt, MD from the Division of Cardiology, Brigham and Women's Hospital speaks about Effect Of Sacubitril/Valsartan vs. Enalapril On Changes In Heart Failure Therapies Over Time: The PARADIGM-HF Trial.

Link to Article:

Summary -


In individuals with heart failure and a low ejection fraction, sacubitril/valsartan reduces morbidity and death (HFrEF). It's unclear if starting sacubitril/valsartan restricts the usage and dose of other aspects of HFrEF medical treatment based on guidelines. In a large randomized clinical study, researchers evaluated the effects of sacubitril/valsartan vs enalapril on -blocker and mineralocorticoid receptor antagonist (MRA) usage and dosage.

Approaches and outcomes:

Patients who provided complete information on their drug usage were included in the study. Through a 12-month follow-up, we looked at the usage of -blockers and MRAs in individuals who were randomized to sacubitril/valsartan vs. enalapril. Between treatment groups, new initiations and discontinuations of -blocker and MRA were compared. At baseline, 8398 people (99.9%) had complete drug and dosage information. The usage of -blockers and MRA at any dose was 87 percent and 56 percent, respectively, at the start of the study. At baseline, 6-month, and 12-month follow-up, the mean dosages of -blocker and MRA were similar between treatment groups. For -blockers [37 (9.0 percent ) vs. 42 (10.2 percent ), P = 0.56] and MRA [127 (7.6 percent ) vs. 143 (9.2 percent ), P = 0.10], new initiations were uncommon and comparable in the sacubitril/valsartan and enalapril groups during 12-month follow-up. At 12 months, patients on sacubitril/valsartan had fewer MRA discontinuations than those on enalapril [125 (6.2 percent) vs. 187 (9.0 percent), P = 0.001]. In the follow-up, there were no significant differences in -blocker discontinuations across groups (2.2 percent vs. 2.6 percent, P = 0.26).


Even when titrated to target dosage, the use of sacubitril/valsartan did not appear to increase the cessation or dose down-titration of other major guideline-directed medical treatments, and it was linked to fewer MRA discontinuations. When compared to enalapril, the combination of sacubitril/valsartan may encourage long-term MRA use.