PIONEER-HF

Comparison of Sacubitril/Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilized from an Acute Heart Failure Episode

Patient / Population Intervention / Exposure Comparison Outcome

In 881 patients hospitalised for acute decompensated HFrEF, in-hospital initiation of sacubitril/valsartan lowered NT-proBNP more than enalapril.

881

Design

Double-blind active-controlled RCT

Endpoint

Time-averaged proportional change in NT-proBNP through weeks 4 and 8

Relevance

ResultNT-proBNP fell -46.7% with sacubitril/valsartan vs -25.3% with enalapril (ratio 0.71, 95% CI 0.63-0.81; P<0.001), with no excess of key safety events.

Velazquez EJ, et al. N Engl J Med. 2019;380(6):539-548. 10.1056/NEJMoa1812851

Discussion & critique

Biomarker (NT-proBNP) primary endpoint rather than clinical outcomes, and short 8-week duration. Demonstrated safe in-hospital initiation of ARNI in stabilised acute HFrEF, shifting practice toward starting sacubitril/valsartan before discharge.