# Number needed to treat met ARNI voor preventie van CV-dood of HF-hospitalisatie

*geplaatst 2018-12-01 · Hartfalen · JAMA cardiology · doi 10.1001/jamacardio.2018.3957 · https://hartvaat.nl/2018/12/01/number-needed-to-treat-met-arni-voor-preventie-van-cv-dood-of-hf-hospitalisatie/*

JAMA Cardiology analyse die het geschatte 5-jaars NNT berekende voor sacubitril/valsartan versus ACE-remmer ter preventie van CV-dood of HF-hospitalisatie.

## English: 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.

This JAMA Cardiology analysis calculated the estimated 5-year number needed to treat with sacubitril-valsartan versus an ACE inhibitor to prevent cardiovascular death or heart failure hospitalization, providing practical data for clinical decision-making and cost-effectiveness assessment.

## Abstract (original, from the publication)

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.

Auteurs: Pratyaksh K Srivastava, Brian L Claggett, Scott D Solomon, John J V McMurray, Milton Packer, Michael R Zile, Akshay S Desai, Jean L Rouleau, Karl Swedberg, Gregg C Fonarow

---
Bron: JAMA cardiology, https://doi.org/10.1001/jamacardio.2018.3957. Bijgewerkt 2026-07-03T13:26:52Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.