PARADIGM-HF

Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality

Paziente / Popolazione Intervento / Esposizione Confronto Esito

In 8,442 patients with HFrEF (EF ≤ 0.40), sacubitril/valsartan reduced CV death or hospitalisation for HF compared with enalapril.

8442

Disegno

Double-blind RCT, terminated early

Esito

CV death or HF hospitalisation

Rilevanza

Risultato21.8 % vs 26.5 % (HR 0.80). All-cause mortality also reduced.

McMurray JJV, et al. N Engl J Med. 2014;371(11):993-1004. 10.1056/NEJMoa1409077

Discussione e critica

Run-in period excluded intolerant patients (~ 20 %), which may inflate efficacy estimates. ARNI replaced ACEi as preferred RAAS-blocker in HFrEF guidelines.