Author + information
- Joanne Simpson,
- Pardeep Jhund,
- Jean Rouleau,
- Karl Swedberg,
- Michael Zile,
- Martin Lefkowitz,
- Victor Shi,
- Scott Solomon,
- Milton Packer and
- John McMurray
Background: Heart failure with reduced ejection fraction (HFREF) has many different causes and etiology varies by age, gender, geography and race/ethnicity. Clinical outcome may also vary by etiology. Controversially, it has been suggested that the effectiveness of certain treatments varies by etiology.
Methods: In this post hoc analysis, we examined the effect of sacubitril/valsartan, compared with enalapril, according to etiology in the 8399 randomized HFREF patients in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF). Investigators were asked to report etiology as ischemic or non-ischemic, with non-ischemic etiology further sub-classified as idiopathic, hypertensive, infective/viral, alcoholic, valvular, diabetic, drug-related, peripartum-related, and “other”. In this analysis, non-ischemic etiology was sub-divided as idiopathic, hypertensive and all others. The primary endpoint in PARADIGM-HF was the composite of CV death or HF hospitalization and we also examined the effect of treatment on CV death alone.
Results: The benefit of sacubitril/valsartan over enalapril was consistent across etiology subgroups (Table 1) with no evidence that etiology modified treatment effect (interaction p-value for primary endpoint=0.22; CV death=0.13).
Conclusions: Sacubitril/valsartan is effective in ischemic and non-ischemic cardiomyopathy, including the major subgroups of non-ischemic etiology.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure and Cardiomyopathies: Heart Failure Is Just a Revolving Door
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1293-252
- 2017 American College of Cardiology Foundation