PIONEER-HF: a new frontier in the role of neprilysin inhibition in the management of heart failure with reduced ejection fraction
The addition of a neprilysin inhibitor to a renin –angiotensin system (RAS) antagonist, using the combination of sacubitril and valsartan, was shown to reduce morbidity and mortality in outpatients with chronic heart failure and reduced ejection fraction (HFrEF).1 In PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure trial), sacubitril/valsartan reduced the risk of cardiovascular death or heart failure (HF) hospitalization by 20%, compared with a RAS blocker alone [the gold-standard angiotensin-converting enzyme (ACE)-inhibitor enalapril]. Consequently, international guidelines have recommended adding a neprilysin inhibitor in patients with HFrEF who remain symptomatic despite treatment with a RAS antagonist, beta-blocker, and mineralocorticoid receptor antagonist [by switching from existing ACE-inhibitor or angiotensin II receptor blocker (ARB) to sacubitril/valsartan].2 However, there remained a series of unanswered questions as to the role of sacubitril/valsartan in particular subgroups of patients: PARADIGM-HF did not recruit hospitalized patients; it required patients to be tolerant of maximal doses of both enalapril and sacubitril/valsartan during sequential single-blinded run-in periods prior to randomization; and it did not include patients who were ACE-inhibitor or ARB na ïve.
PMID: 32929710 [PubMed - in process]
CONCLUSIONS: AD is responsible for an increasing proportion of hospitalizations in Spain and raising medical costs, which highlights the importance of early detection and optimized care. PMID: 32928002 [PubMed - as supplied by publisher]
Conclusions: As postoperative mortality in case of COVID pneumonia is not negligible, meticulous rules (precise triage, safe hospital path, high level of protection for health-care teams, prompt diagnosis of suspicious symptoms) should be strictly followed in patients undergoing CS during COVID pandemic. The role of therapies alternative to CS should be further assessed.
Conclusions: This large matched-cohort study identified the minimum weight loss thresholds for reduction in risk of MACE and all-cause mortality in patients with obesity and diabetes. Furthermore, in our analysis, the effect of surgery was still present after accounting for weight loss, which may suggest the presence of weight-independent beneficial effects of metabolic surgery on MACE and survival.
We request that the following corrections be made in our article.
Atrial fibrillation and peripheral arterial disease are two conditions associated with high risk of cardiovascular and cerebrovascular complications and mortality.1 –5 There is evidence that coexistence of both these clinical conditions can result to an additive risk of adverse events.6 Indeed, atherosclerotic vascular disease has been linked with stroke, thromboembolism and death in subjects with atrial fibrillation and has been therefore included as one of the components of risk scores, such as the CHA2DS2-VASc score (Congestive Heart failure, Hypertension Age> 75 years, DM, Stroke, Vascular disease) in order to...
New sports cardiology guidelines green-light participation in vigorous competitive sports by selected patients with stable coronary artery disease, heart failure, or mild arrhythmiasMedscape Medical News
Publication date: October 2020Source: American Heart Journal, Volume 228Author(s): Valeria Paradies, Huili Zheng, Heerajnarain Bulluck, Derek J. Hausenloy
Publication date: October 2020Source: American Heart Journal, Volume 228Author(s): Nora Rossberg, Ali Kirresh, Mahmood Ahmad
September 9, 2020 To: American College of Cardiology American College of Chest Physicians American College of Physicians American College of Radiology American Heart Association American Society of Echocardiography American Thoracic Society European Association of Cardiovascular Imaging European Society of Cardiology European Society of Radiology Heart Rhythm Society Infectious Disease Society of America North American Society of Cardiovascular Imaging Radiologic Society of North America Society of Cardiovascular Magnetic Resonance Soci...