Posted by Brigham and Women's Hospital January 26, 2016
Contributor: Scott D. Solomon, MD is Director of Noninvasive Cardiology and Edward D. Frohlich Distinguished Chair in Cardiovascular Pathophysiology at Brigham and Women’s Hospital and Professor of Medicine at Harvard Medical School. His interests include cardiovascular disease and heart failure.
New Brigham and Women’s Hospital (BWH) research suggests that certain heart failure patients may extend their life by switching medications. The BWH-led study finds that patients with reduced ejection fraction (reduced ability to pump blood from the heart) can expect to live one-and-a-half to two years longer when treated with sacubitril-valsartan instead of enalapril, the current standard of care in heart failure.
Heart failure, the leading cause of hospitalization for Americans over the age of 65, accounts for more than one million hospitalizations in the U.S. each year. About half of the nearly six million Americans living with heart failure have the reduced ejection fraction form of the disease, which bears a significantly increased risk for future cardiac events and death.
“These results help both patients and their physicians understand the impact of switching from the standard of care to sacubitril-valsartan, in terms of a benefit that they can easily understand,” says Scott D. Solomon, MD, senior author, Director of Noninvasive Cardiology and Edward D. Frohlich Distinguished Chair in Cardiovascular Pathophysiology at BWH, and Professor of Medicine at Harvard Medical School. “Patients want to know how much longer they are going to live, rather than how much their risk will be reduced.”
For the new analysis, researchers examined data from 8,399 patients in the PARADIGM-HF study, the largest heart failure clinical trial ever conducted. They used actuarial methods typically employed by the insurance industry to measure the estimated lifetime benefits of treatment with sacubitril-valsartan.
Assuming that the protective effects of sacubitril-valsartan remain consistent over long-term use, researchers estimate that the medication’s benefits are similar across a wide range of ages. Specifically, patients 45-75 years old who are treated with sacubitril-valsartan reap a projected benefit of one to two years of increased life expectancy – free from heart failure hospitalization – when compared to patients of the same age who are treated with enalapril.
These findings, which were published in the New England Journal of Medicine, build upon the 2014 results of the PARADIGM-HF trial. Those findings showed that sacubitril-valsartan was superior to enalapril in reducing the rates of hospitalization for heart failure, death from cardiovascular causes, and death from any cause among heart failure patients with reduced ejection fraction. The study was stopped early because of the overwhelming evidence of sacubitril-valsartan’s benefits.
– Haley B., Chris P.