Estimated 5-Year number needed to treat to prevent cardiovascular death or heart failure hospitalization with angiotensin receptor-neprilysin inhibition vs standard therapy for patients with heart failure with reduced ejection fraction: An analysis of data from the PARADIGM-HF Trial
Journal article
Srivastava, Pratyaksh K., Claggett, Brian L., Solomon, Scott, McMurray, John J. V., Packer, Milton, Zile, Michael R., Desai, Akshay S., Rouleau, Jean L., Swedberg, Karl and Fonarow, Gregg C.. (2018). Estimated 5-Year number needed to treat to prevent cardiovascular death or heart failure hospitalization with angiotensin receptor-neprilysin inhibition vs standard therapy for patients with heart failure with reduced ejection fraction: An analysis of data from the PARADIGM-HF Trial. JAMA Cardiology. 3(12), pp. 1226 - 1231. https://doi.org/10.1001/jamacardio.2018.3957
Authors | Srivastava, Pratyaksh K., Claggett, Brian L., Solomon, Scott, McMurray, John J. V., Packer, Milton, Zile, Michael R., Desai, Akshay S., Rouleau, Jean L., Swedberg, Karl and Fonarow, Gregg C. |
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Abstract | Importance: The addition of receptor-neprilysin inhibition to standard therapy, including a renin-angiotensin system blocker, has been demonstrated to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF) compared with standard therapy alone. The long-term absolute risk reduction from angiotensin receptor neprilysin inhibitor (ARNI) therapy, and whether it merits widespread use among diverse subpopulations, has not been well described. Objective: To calculate estimated 5-year number needed to treat (NNT) values overall and for different subpopulations for the Prospective Comparison of ARNI with Angiotensin-Converting Enzyme Inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) cohort. Design, Setting, and Participants: Overall and subpopulation 5-year NNT values were estimated for different end points using data from PARADIGM-HF, a double-blind, randomized trial of sacubitril-valsartan vs enalapril. This multicenter, international study included 8399 men and women with HFrEF (ejection fraction, ≤40%). The study began in December 2009 and ended in March 2014. Analyses began in March 2018. Interventions: Random assignment to sacubitril-valsartan or enalapril. Main Outcomes and Measures: Cardiovascular death or HF hospitalization, cardiovascular death, and all-cause mortality. Results: The final cohort of 8399 individuals included 1832 women (21.8%) and 5544 white individuals (66.0%), with a mean (SD) age of 63.8 (11.4) years. The 5-year estimated NNT for the primary outcome of cardiovascular death or HF hospitalization with ARNI therapy incremental to ACEI therapy in the overall cohort was 14. The 5-year estimated NNT values were calculated for different clinically relevant subpopulations and ranged from 12 to 19. The 5-year estimated NNT for all-cause mortality in the overall cohort with ARNI incremental to ACEI was 21, with values ranging from 16 to 31 among different subgroups. Compared with imputed placebo, the 5-year estimated NNT for all-cause mortality with ARNI was 11. The 5-year estimated NNT values were also calculated for other HFrEF therapies compared with controls from landmark trials for all-cause mortality and were found to be 18 for ACEI, 24 for angiotensin receptor blockers, 8 for β-blockers, 15 for mineralocorticoid antagonists, 14 for implantable cardioverter defibrillator, and 14 for cardiac resynchronization therapy. Conclusions and Relevance: The 5-year estimated NNT with ARNI therapy incremental to ACEI therapy overall and for clinically relevant subpopulations of patients with HFrEF are comparable with those for well-established HF therapeutics. These data further support guideline recommendations for use of ARNI therapy among eligible patients with HFrEF. |
Year | 2018 |
Journal | JAMA Cardiology |
Journal citation | 3 (12), pp. 1226 - 1231 |
Publisher | American Medical Association |
ISSN | 2380-6583 |
Digital Object Identifier (DOI) | https://doi.org/10.1001/jamacardio.2018.3957 |
Scopus EID | 2-s2.0-85057874558 |
Page range | 1226 - 1231 |
Research Group | Mary MacKillop Institute for Health Research |
Publisher's version | File Access Level Controlled |
Place of publication | United States of America of America |
https://acuresearchbank.acu.edu.au/item/8v320/estimated-5-year-number-needed-to-treat-to-prevent-cardiovascular-death-or-heart-failure-hospitalization-with-angiotensin-receptor-neprilysin-inhibition-vs-standard-therapy-for-patients-with-heart
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