Tag Archives: PARADIGM-HF

The patients who developed cardiotoxicity were treated with beta blockers (carvedilol), angiotensin-converting enzyme inhibitors (enalapril) or angiotensin receptor blockers (valsartan), aldosterone antagonists (eplerenone), digitalis and diuretics (furosemide), as needed. When patients remained symptomatic and met the PARADIGM-HF inclusion criteria, sacubitril/valsartan was started instead of enalapril or valsartan. Results showed that sacubitril/valsartan therapy produced an improvement in ventricular remodelling, diastolic dysfunction, and on symptoms, reflected in the New York Heart Association class and the six-minute walk test. The auth

Landmark trials in heart failure – 30 years from CONSENSUS With 2017 marking the 30th year since the publication of CONSENSUS,1 which first reported a reduction in mortality with enalapril versus placebo in patients with advanced heart failure (HF), the BCS held a dedicated session to review the seminal clinical trials and advances in chronic heart failure management in this period. Dr Rosita Zakeri (Royal Brompton Hospital, London) reviewed this session for us and spoke to the BJC afterwards. Rosita Zakeri The era of vasodilator therapy for heart failure began in the 1990s. Professor Karl Swedberg (University of Gothenberg, Sweden) began

Targeting uric acid Dr Richard Crawley (Portsmouth Hospitals NHS Trust) The conference’s keynote lecture, delivered by Professor Austin Stack (University Hospital, Limerick, Ireland), homed in on the idea that serum uric acid directly contributes to increased cardiovascular disease. This was shown in his team’s work published in 2013,1 which used retrospective data to identify a direct correlation between raised serum uric acid concentrations and increased risk of developing cardiovascular disease. This, therefore, begs two questions: Firstly, does uric acid directly cause vascular endothelial damage, contributing to acute renal dysfunct

Sacubitril/valsartan (Entresto™, Novartis), the first angiotensin receptor blocker (ARB) and neprilysin inhibitor (NEP) combination – known as an angiotensin-receptor-neprilysin inhibitor (ARNI) – has recently been approved by the National Institute for Health and Care Excellence (NICE) in the treatment of patients with chronic heart failure.1 The guidance, largely based on results from the landmark PARADIGM- HF study,2 recommends sacubitril/valsartan as an “option” for symptomatic patients (New York Heart Association [NYHA] class II– IV) who have an ejection fraction of 35% or less and are established on a “stable dose” of an

The 2016 guidelines include for the first time the new drug sacubitril/valsartan (previously known as LCZ696). This is the first drug in the class of angiotensin receptor neprilysin inhibitors (ARNIs) and was shown in the PARADIGM-HF trial to be superior to the angiotensin-converting enzyme (ACE) inhibitor enalapril for reducing the risk of death and hospitalisation in patients with heart failure with reduced ejection fraction (HFREF) who met strict inclusion and exclusion criteria. Professor Piotr Ponikowski (Chairperson of the ESC Guidelines Task Force), said: “The issue of how to include LCZ696 in the treatment algorithm generated a lot

Approval for new heart failure treatment A breakthrough drug for the treatment of chronic heart failure is now available in the UK.  The new drug sacubitril/valsartan (Entresto®, Novartis) has been approved for the treatment of adults with symptomatic heart failure with reduced left ventricular ejection fraction (HFREF). Sacubitril/valsartan – the first drug in the angiotensin receptor neprilysin inhibitor (ARNI) class of drugs – was found to be superior to an evidence-based dose of the angiotensin-converting enzyme (ACE) inhibitor, enalapril, in the PARADIGM-HF study, the largest heart failure study conducted to date. PARADIGM-HF (Pros

Acute heart failure The first of the clinical heart failure sessions, delivered by Professor Theresa McDonagh (King’s College Hospital, London), considered the definition of acute heart failure (AHF) and how this has been simplified over recent years from a minefield of overlapping statements set out in 2008. Acute hypertensive heart failure, acutely decompensated chronic heart failure, acute coronary syndrome (ACS) and heart failure, right heart failure – amongst other terminology – have now been categorised into: ‘puffers’ – pulmonary oedema, fluid distribution error and ‘bloaters’ – peripheral oedema with genuine fluid

Bridging the gap: from trials to inner cities Within the field of heart failure, there is a breadth of prognostic therapies derived from large, randomised controlled trials. Professor Iain Squire (Glenfield Hospital, Leicester) described how new treatments require approval in the European Union before they can be implemented into clinical practice within the member states. The European Medicines Agency (EMA) ensures the best use of scientific resources across Europe. While certain classes of technologies must undergo licencing via a centralised procedure, most therapies will be eligible for licensing by one member state on behalf of other na

BHF to spend half a billion pounds on research A new research strategy has been launched by the British Heart Foundation (BHF), aiming to fund over half a billion pounds of new cardiovascular research over the next five years. The BHF’s new strategy includes a commitment to continue funding the best researchers working across all areas of cardiovascular disease research.  This includes a pledge by the BHF to help women stay in research after a review highlighted the underrepresentation of women in senior cardiovascular research roles. Also, for the first time, the BHF will fund healthcare professionals, such as nurses, by establishing a de

Managing risk factors – the old offenders Diet An update on diet and cardiovascular disease was given by Professor Kay Tee Khaw (University of Cambridge). A surprise recent finding has been that increased body mass index (BMI) trends do not directly correlate with cardiovascular mortality, particularly in Mediterranean countries (figure 1). Figure 1. Body mass index and associated coronary heart disease in Europe. Panel a) body mass index; panel b) coronary heart disease This gives rise to the question: is diet a key moderating factor in the relationship between BMI and cardiovascular mortality? The PREDIMED (Effects of the Mediterranean Di