Effect of Treatment With Sacubitril/Valsartan in Patients With Advanced Heart Failure and Reduced Ejection Fraction A Randomized Clinical Trial

Treatment with evidence-based medical therapies improves survival, reduces heart failure hospitalizations, and improves quality of life in patients with chronic heart failure with a reduced ejection fraction.13 However, the evidence supporting the use of medical therapies among patients with advanced heart failure is less robust, given that it may be difficult to reach the target drug doses that are achieved in clinical trials that enroll patients with milder symptoms, and patients with New York Heart Association (NYHA) class IV heart failure are not often enrolled in phase 3 clinical trials.47 The landmark Prospective Comparison of Angiotensin II Receptor Blocker Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial reported that, compared with the angiotensin-converting enzyme inhibitor enalapril, sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor, reduced the relative risk of cardiovascular mortality and heart failure hospitalizations by 20% in ambulatory patients with heart failure with a reduced ejection fraction.

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