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Heart failure is a continuous, progressive disease—are your patients’ therapies optimized?

Even if your heart failure patients seem clinically stable, their underlying disease may be progressing1-3
Cardiac Function Graph

Adapted from Mesquita ET, Jorge AJL, Rabelo LM, et al. Int J Cardiovasc Sci. 2017;30(1):81-90. ©The International Journal of Cardiovascular Sciences

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  • Sudden cardiac death accounts for 40% to 45% of all deaths in HFrEF patients4

  • In a study with a median follow-up of 27 months, 1 hospitalization put HFrEF patients at up to 6x greater risk of death vs those who had not been hospitalized for HFrEF5,6

Post hoc analysis of the PARADIGM-HF study, a multinational, randomized, double-blind trial comparing sacubitril/valsartan to enalapril in 8442 symptomatic (NYHA Class II–IV) HFrEF patients (LVEF ≤40%). For the primary end point, composite of CV death or first HF hospitalization, sacubitril/valsartan was superior to enalapril (P<.0001). This post hoc analysis examined the association of first nonfatal events—either HF hospitalization, ED visit, or outpatient intensification of HF therapy—with subsequent mortality during the trial. For the 1107 patients in the study who had a hospitalization for worsening HF as a first event, vs those with no event, the HR for mortality was 6.1 (95% CI: 5.4–6.8).5,6

In the 2022 AHA/ACC/HFSA Heart Failure Guideline, ENTRESTO is recommended as a first-line treatment and to replace well-tolerated ACEi/ARB in patients with NYHA Class II–III HFrEF (Class 1 recommendation).
*In PARAGON-HF, defined as LVEF ≥45% with structural heart disease (LAE or LVH); median LVEF was 57%. LVEF is a variable measure and the normal range can vary.6

ACEi, angiotensin-converting enzyme inhibitor; ARB; angiotensin II receptor blocker; CI, confidence interval; CV, cardiovascular; ED, emergency department; HR, hazard ratio; NYHA, New York Heart Association; RASi, renin-angiotensin system inhibitor.

1. Sabbah HN. Silent disease progression in clinically stable heart failure. Euro J Heart Fail. 2017;19:469-478. doi:10.1002/ejhf.7054
2. Gheorghiade N, De Luca L, Fonarow GC, et al. Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol. 2005;96(suppl):11G-17G. doi:10.1016/j.amjcard.2005.07.016
3. Mesquita ET, Jorge AJL, Rabelo LM, Souza CV. Understanding hospitalization in patients with heart failure. Int J Cardio Sci. 2017;30(1):81-90. doi:10.5935/2359-4802.2016006
4. Masarone D, Limongelli G, Ammendola E, et al. Risk stratification of sudden cardiac death in patients with heart failure: an update. J Clin Med. 2017;7(11):436. doi:10.3390/jcm71104365
5. Okumura N, Jhund PS, Gong J, et al. Importance of clinical worsening of heart failure treated in the outpatient setting: evidence from the prospective comparison of ARNi with ACEi to determine impact on global mortality and morbidity in heart failure trial (PARADIGM-HF). Circ. 2016;133:2254-2262. doi:10.1161/circulationaha.115.020729
6. ENTRESTO [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp.
7. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263-e421. doi:10.1016/j.jacc.2021.12.012