Response to the Letter to the Editor – “The PARADIGM-HF population may be very different from real-world heart failure patients”

Rodrigues, Gustavo; Tralhão, António; Aguiar, Carlos; Freitas, Pedro; Ventosa, António; Mendes, Miguel

doi:10.1016/j.repce.2019.03.006

Revista Portuguesa de Cardiologia (English edition)

ISSN: 2174-2049

The Portuguese Journal of Cardiology, the official journal of the Portuguese Society of Cardiology, was founded in 1982 with the aim of keeping Portuguese cardiologists informed through the publication of scientific articles on areas such as arrhythmology and electrophysiology, cardiovascular surgery, intensive care, coronary artery disease, cardiovascular imaging, hypertension, heart failure and cardiovascular prevention. The Journal is a monthly publication with high standards of quality in terms of scientific content and production. Since 1999 it has been published in English as well as Portuguese, which has widened its readership abroad. It is distributed to all members of the Portuguese Societies of Cardiology, Internal Medicine, Pneumology and Cardiothoracic Surgery, as well as to leading non-Portuguese cardiologists and to virtually all cardiology societies worldwide. It has been referred in Medline since 1987.

Indexed in:

Index Medicus/Medline, Science Citation Index Expanded/Journal of Citation Reports, Scopus

As highlighted by our analysis,1 the epidemiological study in Lima2 pertinently quoted by Walter Calderón, and another two large registries,3,4 patients from randomized trials are frequently different from those found in our daily practice. However, the results of the PARADIGM-HF trial are changing and will continue to change the way we treat patients with heart failure and reduced ejection fraction.

Recently, the TRANSITION trial demonstrated the safety of sacubitril/valsartan when initiated prior to discharge from hospitalization for heart failure, achieving similar titration rates (62% vs. 68%),5 and PIONEER-HF showed that in-hospital initiation of sacubitril/valsartan further reduced NT-proBNP values (ratio of NT-proBNP at week 4 and 8 to baseline value: 0.53 vs. 0.75).6

Concluding, different pieces of an intricate puzzle are coming together, contributing to the widespread adoption of neuromodulation in patients with heart failure and reduced ejection fraction.

Conflicts of interest

The authors have no conflicts of interest to declare.

References

[1]

G. Rodrigues, A. Tralhao, C. Aguiar, et al.

Is the PARADIGM-HF cohort representative of the real-world heart failure patient population?.

Rev Port Cardiol, 37 (2018), pp. 491-496

http://dx.doi.org/10.1016/j.repc.2017.09.023 | Medline

[2]

M. Pariona, P.A. Segura Saldana, M. Padilla Reyes, et al.

Epidemiological clinical characteristics of acute cardiac insufficiency in a tertiary hospital in Lima, Peru.

Rev Peru Med Exp Sal Publ, 34 (2017), pp. 655-659