PARADIGM-HF: Prospective Comparison of ARNI With ACEI to Determine Impact on Global HF Mortality and Morbidity

In a prospective comparison of the angiotensin receptor neprilysin inhibition (ARNI) drug LCZ696 against the angiotensin-converting enzyme inhibitor (ACEI) Enalapril and their potential impact on global mortality and morbidity in heart failure, among the various benefits, LCAZ696 slows progression of heart failure, preventing and delaying fatal and non-fatal worsening, according to results of the PARADIGM-HF trial presented Nov. 17 at AHA 2014.

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Overseen by principal author John McMurray, MD, FACC, the study’s researchers conducted a one to one randomization of 8,442 patients (LCZ696, n=4,187; Enalapril, n=4,212). After three and a half years, data showed that death from cardiovascular causes occurred in 693 patients treated with Enalapril and 558 with LCZ696, and that heart failure hospitalization occurred in 658 patients with Enalapril and 537 with LCZ696, a risk reduction of 20 percent and 21 percent, respectively. Death from any cause occurred in 835 patients treated with Enalapril and 711 with LCZ696, a 16 percent risk reduction.

Further, compared with Enalapril, results showed that patients on LCZ696 are less likely show symptomatic deterioration, are less likely to need intensification of oral therapy and addition of IV therapy, are less likely to visit the emergency room, are less likely to be admitted to the hospital, and, if admitted, are less likely to go to the intensive care unit and less likely to need IV inotropic therapy.  In addition, patients on LCZ696 are also less likely to require devices or surgery for worsening or end-stage heart failure, are less likely to die prematurely either from sudden or worsening heart failure, and are less likely to show biomarker evidence of cardiac wall-stress and myocyte injury.

Keywords: Intensive Care Units, Enalapril, Risk Reduction Behavior, Aminobutyrates, Receptors, Angiotensin, Angiotensin-Converting Enzyme Inhibitors, Heart Failure, Emergency Service, Hospital, Neprilysin, Tetrazoles, Hospitalization, Receptors, Drug

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