Recent heart failure (HF) hospitalization may represent a risk predictor of recurrent clinical events and "potentially identifies a group of patients with heart failure with preserved ejection fraction (HFpEF) who might be particularly responsive to sacubitril-valsartan," according to a post-hoc analysis of the PARAGON-HF trial published Nov. 11 in the Journal of the American College of Cardiology, and presented during AHA 2019 in Philadelphia, PA.

Muthiah Vaduganathan, MD, MPH, et al., looked at 4,796 patients in the PARAGON-HF trial to assess the risk of clinical events and response to use of the angiotensin receptor-neprilysin inhibitor sacubitril-valsartan in relation to time from last HF hospitalization among patients with HFpEF (≥45 percent).

Results showed that over a median of 35 months of follow-up, the primary outcome – a composite of total HF hospitalizations and cardiovascular death – was "inversely and non-linearly associated with timing from prior HF hospitalization (P<0.001)." They add that there was a "gradient in relative risk reduction in primary events with sacubitril-valsartan from patients hospitalized within 30 days to patients never hospitalized."

The authors conclude that their data suggest that "recent HF hospitalization identifies HFpEF patients at enriched risk for adverse outcomes that may be modifiable with sacubitril-valsartan." They add that the "relative and absolute benefits of sacubitril-valsartan compared with valsartan in HFpEF appear to be amplified when initiated in the high-risk window after hospitalization and warrants prospective validation."

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: AHA19, AHA Annual Scientific Sessions, Stroke Volume, Heart Failure, Dyslipidemias

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