{"id":"0ddba7056953","type":"article","url":"https://hartvaat.nl/2020/01/28/eerdere-hf-hospitalisatie-en-sacubitril-valsartan-versus-valsartan-bij-hfpef-par/","title":"Eerdere HF-hospitalisatie en sacubitril/valsartan versus valsartan bij HFpEF: PARAGON-HF","title_en":"Prior Heart Failure Hospitalization, Clinical Outcomes, and Response to Sacubitril/Valsartan Compared With Valsartan in HFpEF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["answer-hf"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.11.003","source_url":"https://doi.org/10.1016/j.jacc.2019.11.003","authors":["Muthiah Vaduganathan","Brian L Claggett","Akshay S Desai","Stefan D Anker","Sergio V Perrone","Stefan Janssens","Davor Milicic","Juan L Arango","Milton Packer","Victor C Shi","Martin P Lefkowitz","John J V McMurray","Scott D Solomon"],"significance":6,"published":"2020-01-28","source_date":"2020-01-28","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/farmacologie/mineralocorticoid-antagonisten-farmacologie/"],"congress":"","summary_en":"This PARAGON-HF analysis showed that patients with recent heart failure hospitalization derive greater benefit from sacubitril-valsartan versus valsartan in HFpEF, identifying the highest-risk subgroup within this population.","created":"2026-07-03T10:28:23Z","updated":"2026-07-03T13:27:33Z","licence":"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.","body_markdown":"PARAGON-HF analyse naar eerdere hartfalenhospitalisatie als effect-modificator voor sacubitril/valsartan bij HFpEF.","abstract_original":"BACKGROUND: The period shortly after hospitalization for heart failure (HF) represents a high-risk window for recurrent clinical events, including rehospitalization or death. OBJECTIVES: This study sought to determine whether the efficacy and safety of sacubitril/valsartan varies in relation to the proximity to hospitalization for HF among patients with HF with preserved ejection fraction (HFpEF). METHODS: In this post hoc analysis of PARAGON-HF (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ARB [Angiotensin Receptor Blocker] Global Outcomes in HFpEF), we assessed the risk of clinical events and response to sacubitril/valsartan in relation to time from last HF hospitalization among patients with HFpEF (≥45%). The primary outcome was composite total HF hospitalizations and cardiovascular death, analyzed by using a semiparametric proportional rates method, stratified by geographic region. RESULTS: Of 4,796 validly randomized patients in PARAGON-HF, 622 (13%) were screened during hospitalization or within 30 days of prior hospitalization, 555 (12%) within 31 to 90 days, 435 (9%) within 91 to 180 days, and 694 (14%) after 180 days; 2,490 (52%) were never previously hospitalized. Over a median follow-up of 35 months, risk of total HF hospitalizations and cardiovascular death was inversely and nonlinearly associated with timing from prior HF hospitalization (p < 0.001). There was a gradient in relative risk reduction in primary events with sacubitril/valsartan from patients hospitalized within 30 days (rate ratio: 0.73; 95% confidence interval: 0.53 to 0.99) to patients never hospitalized (rate ratio: 1.00; 95% confidence interval: 0.80 to 1.24; trend in relative risk reduction: pinteraction = 0.15). With valsartan alone, the rate of total primary events was 26.7 (≤30 days), 24.2 (31 to 90 days), 20.7 (91 to 180 days), 15.7 (>180 days), and 7.9 (not previously hospitalized) per 100 patient-years. Compared with valsartan, absolute risk reductions with sacubitril/valsartan were more prominent in patients enrolled early after hospitalization: 6.4% (≤30 days), 4.6% (31 to 90 days), and 3.4% (91 to 180 days), whereas no risk reduction was observed in patients screened >180 days or who were never hospitalized (trend in absolute risk reduction: pinteraction = 0.050). CONCLUSIONS: Recent hospitalization for HFpEF identifies patients at high risk for near-term clinical progression. In the PARAGON-HF trial, the relative and absolute benefits of sacubitril/valsartan compared with valsartan in HFpEF appear to be amplified when initiated in the high-risk window after hospitalization and warrant prospective validation. (PARAGON-HF; NCT01920711)."}