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.
Source: Cardiovascular Research - Category: Cardiology Source Type: research

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PMID: 32929710 [PubMed - in process]
Source: Cardiology Journal - Category: Cardiology Authors: Tags: Cardiol J Source Type: research
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Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research
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Source: Medscape Medical News Headlines - Category: Consumer Health News Tags: Cardiology News Source Type: news
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Source: American Heart Journal - Category: Cardiology Source Type: research
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Source: American Heart Journal - Category: Cardiology Source Type: research
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...
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