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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSmallCaps">I</span> have read with great interest the article by Rodrigues et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> and the editorial comment<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> about the use of sacubitril&#47;valsartan in patients with systolic heart failure&#44; and <span class="elsevierStyleSmallCaps">I</span> share the same concerns about the target population of this drug&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In an epidemiological study in Lima&#44; Peru&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> of 1075 patients with heart failure&#44; 46&#37; had normal ejection fraction and only 39&#37; had heart failure with reduced ejection fraction &#40;&#8804;40&#37;&#41; &#40;HFrEF&#41;&#46; Overall&#44; 30&#37; of patients with heart failure also had chronic renal disease&#44; leaving only 20-25&#37; of patients eligible for treatment with sacubitril&#47;valsartan&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In a high-altitude population like Huancayo &#40;3250 meters above sea level&#41;&#44; the profile of heart failure patients is even more dissimilar&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> with 89&#46;9&#37; of patients having a normal ejection fraction&#44; while around 25&#37; of individuals have heart failure and chronic lung disease&#44; leaving only 2&#46;2&#37; of patients eligible for this drug&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Another concern is about how many patients will tolerate the target dose of 97&#47;103<span class="elsevierStyleHsp" style=""></span>mg&#44; because as Antol et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> pointed out&#44; only 17&#46;4&#37; of patients in their retrospective study could achieve this goal&#46; Despite this result&#44; the hospitalization rate&#44; symptoms and weight gain decreased in those who were treated with sacubitril&#47;valsartan&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In search of an answer about the profile of patients who will benefit from sacubitril&#47;valsartan&#44; the PARAGON-HF trial<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> is currently under way and will try to determine if the drug is useful for patients with preserved ejection fraction &#40;HFpEF&#41;&#46; Caution must be exercised because drugs used for HFrEF that showed promise for HFpEF did not improve prognosis for this condition when tested in large clinical trials&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">As Ricardo Fontes-Carvalho pointed out in his editorial comment&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> we must recognize that sacubitril&#47;valsartan is an important advance for heart failure therapy&#44; even though its benefits have not been proved in a broader&#44; real-world heart failure population&#46; Taking this into account&#44; new drugs are needed for patients with heart failure who have chronic renal or pulmonary conditions or have normal or intermediate ejection fraction&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Letter to the Editor
The PARADIGM-HF population may be very different from real-world heart failure patients
A população do PARADIGM-HF pode ser muito diferente do mundo real dos pacientes com insuficiência cardíaca
Walter Calderón-Gersteina,b
a Hospital Nacional “Ramiro Prialé Prialé”, Internal Medicine Service, Huancayo, Essalud, Peru
b Univesidad Continental, Huancayo, Peru
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSmallCaps">I</span> have read with great interest the article by Rodrigues et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> and the editorial comment<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> about the use of sacubitril&#47;valsartan in patients with systolic heart failure&#44; and <span class="elsevierStyleSmallCaps">I</span> share the same concerns about the target population of this drug&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In an epidemiological study in Lima&#44; Peru&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> of 1075 patients with heart failure&#44; 46&#37; had normal ejection fraction and only 39&#37; had heart failure with reduced ejection fraction &#40;&#8804;40&#37;&#41; &#40;HFrEF&#41;&#46; Overall&#44; 30&#37; of patients with heart failure also had chronic renal disease&#44; leaving only 20-25&#37; of patients eligible for treatment with sacubitril&#47;valsartan&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In a high-altitude population like Huancayo &#40;3250 meters above sea level&#41;&#44; the profile of heart failure patients is even more dissimilar&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> with 89&#46;9&#37; of patients having a normal ejection fraction&#44; while around 25&#37; of individuals have heart failure and chronic lung disease&#44; leaving only 2&#46;2&#37; of patients eligible for this drug&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Another concern is about how many patients will tolerate the target dose of 97&#47;103<span class="elsevierStyleHsp" style=""></span>mg&#44; because as Antol et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> pointed out&#44; only 17&#46;4&#37; of patients in their retrospective study could achieve this goal&#46; Despite this result&#44; the hospitalization rate&#44; symptoms and weight gain decreased in those who were treated with sacubitril&#47;valsartan&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In search of an answer about the profile of patients who will benefit from sacubitril&#47;valsartan&#44; the PARAGON-HF trial<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> is currently under way and will try to determine if the drug is useful for patients with preserved ejection fraction &#40;HFpEF&#41;&#46; Caution must be exercised because drugs used for HFrEF that showed promise for HFpEF did not improve prognosis for this condition when tested in large clinical trials&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">As Ricardo Fontes-Carvalho pointed out in his editorial comment&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> we must recognize that sacubitril&#47;valsartan is an important advance for heart failure therapy&#44; even though its benefits have not been proved in a broader&#44; real-world heart failure population&#46; Taking this into account&#44; new drugs are needed for patients with heart failure who have chronic renal or pulmonary conditions or have normal or intermediate ejection fraction&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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