Jasper Tromp1,2,3,4, Brian L Claggett5, Jiankang Liu5, Alice M Jackson6, Pardeep S Jhund6, Lars Køber7, Jiří Widimský8, Sergey A Boytsov9, Vijay K Chopra10, Inder S Anand11, Junbo Ge12, Chen-Huan Chen13, Aldo P Maggioni14, Felipe Martinez15, Milton Packer16, Marc A Pfeffer5, Burkert Pieske17, Margaret M Redfield18, Jean L Rouleau19, Dirk J Van Veldhuisen3, Faiez Zannad20, Michael R Zile21, Adel R Rizkala22, Akiko Inubushi-Molessa22, Martin P Lefkowitz22, Victor C Shi22, John J V McMurray6, Scott D Solomon5, Carolyn S P Lam1,2,3. 1. National Heart Centre Singapore (J.T., C.S.P.L.). 2. Duke-NUS Medical School, Singapore (J.T., C.S.P.L.). 3. Department of Cardiology, University Medical Centre Groningen, University of Groningen, the Netherlands (J.T., D.J.V.V., C.S.P.L.). 4. Saw Swee Hock School of Public Health, National University of Singapore, Singapore (J.T.). 5. Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.L.C., J.L., M.A.P., S.D.S.). 6. British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.M.J., P.S.J., J.J.V.M.). 7. Department of Cardiology, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.). 8. First Faculty of Medicine, Charles University Prague, Czech Republic (J.W.). 9. National Research Center for Cardiology of the Ministry of Health of the Russian Federation, Moscow (S.B.). 10. Heart Failure and Research Max Super Specialty Hospital Saket, New Delhi, India (V.C.). 11. Department of Medicine, VA Medical Center and University of Minnesota, Minneapolis (I.S.A.). 12. Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, China (J.G.). 13. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China (C.-H.C.). 14. Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy (A.P.M.). 15. Universidad Nacional of Cordoba, Argentina (F.M.). 16. Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.). 17. Department of Internal Medicine, Cardiology Charité, Universitaetsmedizin Berlin, Campus Virchow Klinikum Berlin, Germany (B.P.). 18. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.M.R.). 19. Institut de Cardiologie de Montréal, Université de Montréal, QC, Canada (J.L.R.). 20. Inserm CIC 1433 and Université de Lorraine, Centre Hospitalier Régional Universitaire, Nancy, France (F.Z.). 21. Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.). 22. Novartis Pharmaceuticals Corporation, East Hanover, NJ (A.R.R., A.I.-M., M.P.L., V.C.S.).
Abstract
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a global public health problem with important regional differences. We investigated these differences in the PARAGON-HF trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in HFpEF), the largest and most inclusive global HFpEF trial. METHODS: We studied differences in clinical characteristics, outcomes, and treatment effects of sacubitril/valsartan in 4796 patients with HFpEF from the PARAGON-HF trial, grouped according to geographic region. RESULTS: Regional differences in patient characteristics and comorbidities were observed: patients from Western Europe were oldest (mean 75±7 years) with the highest prevalence of atrial fibrillation/flutter (36%); Central/Eastern European patients were youngest (mean 71±8 years) with the highest prevalence of coronary artery disease (50%); North American patients had the highest prevalence of obesity (65%) and diabetes (49%); Latin American patients were younger (73±9 years) and had a high prevalence of obesity (53%); and Asia-Pacific patients had a high prevalence of diabetes (44%), despite a low prevalence of obesity (26%). Rates of the primary composite end point of total hospitalizations for HF and death from cardiovascular causes were lower in patients from Central Europe (9 per 100 patient-years) and highest in patients from North America (28 per 100 patient-years), which was primarily driven by a greater number of total hospitalizations for HF. The effect of treatment with sacubitril-valsartan was not modified by region (interaction P>0.05). CONCLUSIONS: Among patients with HFpEF recruited worldwide in PARAGON-HF, there were important regional differences in clinical characteristics and outcomes, which may have implications for the design of future clinical trials. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.
BACKGROUND:Heart failure with preserved ejection fraction (HFpEF) is a global public health problem with important regional differences. We investigated these differences in the PARAGON-HF trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in HFpEF), the largest and most inclusive global HFpEF trial. METHODS: We studied differences in clinical characteristics, outcomes, and treatment effects of sacubitril/valsartan in 4796 patients with HFpEF from the PARAGON-HF trial, grouped according to geographic region. RESULTS: Regional differences in patient characteristics and comorbidities were observed: patients from Western Europe were oldest (mean 75±7 years) with the highest prevalence of atrial fibrillation/flutter (36%); Central/Eastern European patients were youngest (mean 71±8 years) with the highest prevalence of coronary artery disease (50%); North American patients had the highest prevalence of obesity (65%) and diabetes (49%); Latin American patients were younger (73±9 years) and had a high prevalence of obesity (53%); and Asia-Pacific patients had a high prevalence of diabetes (44%), despite a low prevalence of obesity (26%). Rates of the primary composite end point of total hospitalizations for HF and death from cardiovascular causes were lower in patients from Central Europe (9 per 100 patient-years) and highest in patients from North America (28 per 100 patient-years), which was primarily driven by a greater number of total hospitalizations for HF. The effect of treatment with sacubitril-valsartan was not modified by region (interaction P>0.05). CONCLUSIONS: Among patients with HFpEF recruited worldwide in PARAGON-HF, there were important regional differences in clinical characteristics and outcomes, which may have implications for the design of future clinical trials. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.
Authors: María Valero-Muñoz; Albin Oh; Elizabeth Faudoa; Rosa Bretón-Romero; Fatima El Adili; Andreea Bujor; Flora Sam Journal: Circ Heart Fail Date: 2021-08-19 Impact factor: 10.447
Authors: María Valero-Muñoz; Eng Leng Saw; Ryan M Hekman; Benjamin C Blum; Zaynab Hourani; Henk Granzier; Andrew Emili; Flora Sam Journal: Front Cardiovasc Med Date: 2022-08-25