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Prior Heart Failure Hospitalization, Clinical Outcomes, and Response to Sacubitril/Valsartan Compared With Valsartan in HFpEF

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dc.contributor.author Vaduganathan, Muthiah
dc.contributor.author Claggett, Brian L.
dc.contributor.author Desai, Akshay S.
dc.contributor.author Anker, Stefan D.
dc.contributor.author Perrone, Sergio Víctor
dc.contributor.author Janssens, Stefan
dc.contributor.author Milicic, Davor
dc.contributor.author Arango, Juan L.
dc.contributor.author Packer, Milton
dc.contributor.author Shi, Victor C.
dc.contributor.author Lefkowitz, Martin P.
dc.contributor.author McMurray, John J.V.
dc.contributor.author Solomon, Scott D.
dc.date.accessioned 2021-01-29T12:08:08Z
dc.date.available 2021-01-29T12:08:08Z
dc.date.issued 2020-01-28
dc.identifier.citation Vaduganathan, M., Claggett, B.L., Desai, A.S., Anker, S.D., Perrone, S.V., Janssens, S., Milicic, D., Arango, J.L., Packer, M., Shi, V.C., Lefkowitz, M.P., McMurray, J.J.V., Solomon, S.D., 2020. Prior Heart Failure Hospitalization, Clinical Outcomes, and Response to Sacubitril/Valsartan Compared With Valsartan in HFpEF. J Am Coll Cardiol 75, 245–254. https://doi.org/10.1016/j.jacc.2019.11.003 en_US
dc.identifier.uri https://repositorio.fleni.org.ar/handle/123456789/352
dc.identifier.uri https://doi.org/10.1016/j.jacc.2019.11.003
dc.description.abstract Background: The period shortly after hospitalization for heart failure (HF) represents a high-risk window for recurrent clinical events, including rehospitalization or death. Objectives: This study sought to determine whether the efficacy and safety of sacubitril/valsartan varies in relation to the proximity to hospitalization for HF among patients with HF with preserved ejection fraction (HFpEF). Methods: In this post hoc analysis of PARAGON-HF (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ARB [Angiotensin Receptor Blocker] Global Outcomes in HFpEF), we assessed the risk of clinical events and response to sacubitril/valsartan in relation to time from last HF hospitalization among patients with HFpEF (≥45%). The primary outcome was composite total HF hospitalizations and cardiovascular death, analyzed by using a semiparametric proportional rates method, stratified by geographic region. Results: Of 4,796 validly randomized patients in PARAGON-HF, 622 (13%) were screened during hospitalization or within 30 days of prior hospitalization, 555 (12%) within 31 to 90 days, 435 (9%) within 91 to 180 days, and 694 (14%) after 180 days; 2,490 (52%) were never previously hospitalized. Over a median follow-up of 35 months, risk of total HF hospitalizations and cardiovascular death was inversely and nonlinearly associated with timing from prior HF hospitalization (p < 0.001). There was a gradient in relative risk reduction in primary events with sacubitril/valsartan from patients hospitalized within 30 days (rate ratio: 0.73; 95% confidence interval: 0.53 to 0.99) to patients never hospitalized (rate ratio: 1.00; 95% confidence interval: 0.80 to 1.24; trend in relative risk reduction: pinteraction = 0.15). With valsartan alone, the rate of total primary events was 26.7 (≤30 days), 24.2 (31 to 90 days), 20.7 (91 to 180 days), 15.7 (>180 days), and 7.9 (not previously hospitalized) per 100 patient-years. Compared with valsartan, absolute risk reductions with sacubitril/valsartan were more prominent in patients enrolled early after hospitalization: 6.4% (≤30 days), 4.6% (31 to 90 days), and 3.4% (91 to 180 days), whereas no risk reduction was observed in patients screened >180 days or who were never hospitalized (trend in absolute risk reduction: pinteraction = 0.050). Conclusions: Recent hospitalization for HFpEF identifies patients at high risk for near-term clinical progression. In the PARAGON-HF trial, 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 warrant prospective validation. (PARAGON-HF; NCT01920711). en_US
dc.language.iso eng en_US
dc.publisher Elsevier en_US
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Heart Failure en_US
dc.subject Insuficiencia Cardíaca en_US
dc.subject Hospitalization en_US
dc.subject Hospitalización en_US
dc.title Prior Heart Failure Hospitalization, Clinical Outcomes, and Response to Sacubitril/Valsartan Compared With Valsartan in HFpEF en_US
dc.type info:eu-repo/semantics/publishedVersion
dc.type info:eu-repo/semantics/article en_US
dc.description.fil Fil: Vaduganathan, Muthiah. Harvard Medical School. Brigham and Women's Hospital. Cardiovascular Division; Estados Unidos.
dc.description.fil Fil: Claggett, Brian L. Harvard Medical School. Brigham and Women's Hospital. Cardiovascular Division; Estados Unidos.
dc.description.fil Fil: Desai, Akshay S. Harvard Medical School. Brigham and Women's Hospital. Cardiovascular Division; Estados Unidos.
dc.description.fil Fil: Anker, Stefan D. Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies. Division of Cardiology and Metabolism; Alemania. German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung); Alemania.
dc.description.fil Fil: Perrone, Sergio Víctor. Fleni. Departamento de Neurología. Servicio de Cardiología; Argentina.
dc.description.fil Fil: Janssens, Stefan. University Hospitals Leuven. Department of Cardiology; Bélgica.
dc.description.fil Fil: Milicic, Davor. University Hospital Center Zagreb. Department of Cardiovascular Diseases; Croacia.
dc.description.fil Fil: Arango, Juan L. Guatemalan Heart Institute; Guatemala.
dc.description.fil Fil: Packer, Milton. Baylor University Medical Center. Baylor Heart and Vascular Institute; Estados Unidos. Imperial College; Reino Unido.
dc.description.fil Fil: Shi, Victor C. Novartis Pharmaceuticals; Estados Unidos.
dc.description.fil Fil: Lefkowitz, Martin P. Novartis Pharmaceuticals; Estados Unidos.
dc.description.fil Fil: McMurray, John J.V. University of Glasgow. British Heart Foundation Cardiovascular Research Centre; Reino Unido.
dc.description.fil Fil: Solomon, Scott D. Harvard Medical School. Brigham and Women's Hospital. Cardiovascular Division; Estados Unidos.
dc.relation.ispartofVOLUME 75
dc.relation.ispartofNUMBER 3
dc.relation.ispartofPAGINATION 45-254.
dc.relation.ispartofCOUNTRY Estados Unidos
dc.relation.ispartofCITY Nueva York
dc.relation.ispartofTITLE Journal of the American College of Cardiology.
dc.relation.ispartofISSN 1558-3597
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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