[Study PARADIGM-HF - a paradigm shift in the treatment of chronic heart failure]

Area of Science:

• Cardiology
• Pharmacology

Background:

• Chronic heart failure (CHF) remains a significant clinical challenge with limited therapeutic advancements.
• Current treatments for CHF have seen minimal progress in recent years.

Purpose of the Study:

• To evaluate the efficacy and safety of angiotensin-receptor neprilysin inhibitors (ARNIs) in patients with chronic heart failure.
• To assess the impact of dual renin-angiotensin-aldosterone (RAS) system and neprilysin inhibition on cardiovascular outcomes.

Main Methods:

• A large-scale, prospective, randomized, multicenter trial (PARADIGM-HF) involving over 8000 patients.
• Patients had stabilized chronic heart failure with systolic dysfunction (left ventricular ejection fraction ≤40% or 35%) and elevated natriuretic peptide levels.
• Comparison of ARNI (sacubitril-valsartan) treatment versus standard therapy.

Main Results:

• ARNI treatment resulted in a 20% reduction in the primary endpoint (cardiovascular death or hospitalization for heart failure).
• Significant benefits were observed in total and cardiovascular mortality, heart failure hospitalizations, and quality of life.
• The treatment was generally safe, with hypotension being the most common adverse event, rarely requiring treatment discontinuation.

Conclusions:

• Dual inhibition of the RAS and neprilysin with ARNIs represents a potential paradigm shift in the treatment of stable chronic heart failure with systolic dysfunction.
• ARNIs demonstrate significant improvements in major adverse cardiovascular events and mortality.
• The findings support ARNIs as a new therapeutic option for patients with heart failure and reduced ejection fraction.