From the Guidelines
Sacubitril-valsartan is the only medication that has shown a potential reduction in mortality in a specific subgroup of patients with Heart Failure with preserved Ejection Fraction (HFpEF), particularly in women, as evidenced by the PARAGON-HF trial 1.
Medication Overview
The management of HFpEF is primarily focused on symptom relief and the aggressive treatment of risk factors and cardiovascular/noncardiovascular comorbidities according to clinical guidelines 1.
- Sacubitril-valsartan has been studied in the PARAGON-HF trial, which compared it to valsartan in patients with HFpEF, elevated baseline levels of natriuretic peptides, and structural heart disease 1.
- The trial found that sacubitril-valsartan did not reduce the primary composite outcome of total HFH and cardiovascular death compared to valsartan, but a prespecified subgroup analysis showed a potential benefit in women, with a relative risk of 0.73 for the primary outcome 1.
Clinical Considerations
- The use of sacubitril-valsartan in HFpEF patients, particularly women, may be considered based on the results of the PARAGON-HF trial, but more research is needed to confirm these findings 1.
- Other medications, such as beta-blockers and ARBs, may provide symptomatic benefit in HFpEF but have not conclusively shown mortality reduction 1.
- The choice of antihypertensive therapy in HFpEF should be guided by a shared decision-making discussion with the patient, influenced by clinician judgment, and consideration of the patient's individual characteristics and comorbidities 1.
Monitoring and Side Effects
- When initiating sacubitril-valsartan, patients should be monitored for potential side effects, including hypotension, renal dysfunction, and hyperkalemia 1.
- Dose adjustments may be necessary based on the patient's renal function and blood pressure response 1.
From the Research
Medication for Heart Failure with Preserved Ejection Fraction (HFpEF)
- There is evidence to suggest that beta-blockers may reduce mortality in HFpEF, with a meta-analysis of observational cohort and randomized controlled studies showing a 21% reduction in risk of mortality [ 2 ].
- SGLT2 inhibitors, such as empagliflozin, have also shown promise in reducing hospitalization for heart failure in HFpEF patients, although their effect on cardiovascular mortality is unclear [ 3 ].
- Other studies have highlighted the complexity and heterogeneity of HFpEF, suggesting that therapeutic strategies may need to be tailored to individual patient phenotypes [ 4, 5 ].
- However, it is worth noting that some studies have focused on heart failure with reduced ejection fraction (HFrEF) rather than HFpEF, and may not be directly applicable to HFpEF patients [ 6 ].