Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction

Abstract

Supplemental Digital Content is available in the text.

Discharge treatment with angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker after a heart failure hospitalisation is associated with a better prognosis irrespective of left ventricular ejection fraction

“…8,9 In past decades, the treatment of HFrEF has changed dramatically, 10,11 mainly due to ACE inhibitors/ARB, beta blockers, mineralocorticoid receptor antagonists and, more recently, angiotensin receptorneprilysin inhibitors. 10 A recent meta-analysis 12 showed that in patients with LVEF <45% the combination of ACE inhibitors + beta blockers + mineralocorticoid receptor antagonists was the most efficacious to reduce all-cause mortality. Our results are consistent with this finding.…”

Angiotensin Receptor Neprilysin Inhibitor in Japanese Patients With Heart Failure and Reduced Ejection Fraction ― Baseline Characteristics and Treatment of PARALLEL-HF Trial ―

“…At the screening visit, patients' eligibility is assessed by demographics and medical history, LVEF, NYHA class, levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), serum potasof 57 randomized controlled trials published between 1987 and 2015, comparing the efficacy of ACEIs, angiotensin receptor blockers (ARBs), ARNIs, mineralocorticoid receptor antagonists (MRA), and β-blockers and their combinations in reducing all-cause death in patients with HFrEF. 6 In that analysis, combination therapy with ARNIs (sacubitril/valsartan), β-blockers, and MRA was associated with the greatest reduction in all-cause death vs. placebo (hazard ratio [HR] 0.37; 95% confidence interval [CI]: 0.19-0.65) and was superior to all other drug classes or combination therapies that are known to reduce mortality rates in HFrEF. 6 The "Phase III prospective comparison of ARNI with ACEI to determine the noveL beneficiaL trEatment vaLue in Japanese Heart Failure patients" (PARALLEL-HF) study has been designed to evaluate the clinical efficacy and safety of sacubitril/valsartan vs. enalapril in Japanese patients with HFrEF.…”

“…6 In that analysis, combination therapy with ARNIs (sacubitril/valsartan), β-blockers, and MRA was associated with the greatest reduction in all-cause death vs. placebo (hazard ratio [HR] 0.37; 95% confidence interval [CI]: 0.19-0.65) and was superior to all other drug classes or combination therapies that are known to reduce mortality rates in HFrEF. 6 The "Phase III prospective comparison of ARNI with ACEI to determine the noveL beneficiaL trEatment vaLue in Japanese Heart Failure patients" (PARALLEL-HF) study has been designed to evaluate the clinical efficacy and safety of sacubitril/valsartan vs. enalapril in Japanese patients with HFrEF. 7 Data from global clinical trials and disease registries in the USA, Europe and the Asia-Pacific region highlighted several differences in the demographic and clinical characteristics of HF patients in the Asia-Pacific region compared with patients from Western countries; for example, patients from the Asia-Pacific region were younger, had greater comorbidity burden and received lower-than-recommended levels of treatment.…”

BRD4 Interacts with GATA4 to Govern Mitochondrial Homeostasis in Adult Cardiomyocytes

“…This condition represents an enormous burden to the healthcare system accounting for almost 2% of all medical expenditures annually and, despite the current standard of care, carries a dismal prognosis with a 5year mortality approaching 50% 1,2 . The mainstays of currently approved pharmacologic therapy for HF target neurohormonal signaling pathways with beta-adrenergic receptor antagonism, inhibition of the renin-angiotensin system, and augmentation of the natriuretic peptide system, all of which have improved survival in HF patients 3 . Despite these successes, the residual burden of morbidity and mortality in HF remains unacceptably high, underscoring an urgent need for novel treatment approaches 1 .…”