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.repc.2019.02.001

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author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta à Carta ao Editor «A população do PARADIGM-HF pode ser muito diferente do mundo real dos doentes com insuficiência cardíaca»" ] ] "textoCompleto" => "As highlighted by our analysis,<a class="elsevierStyleCrossRef" href="#bib0035">1</a> the epidemiological study in Lima<a class="elsevierStyleCrossRef" href="#bib0040">2</a> pertinently quoted by Walter Calderón, and another two large registries,<a class="elsevierStyleCrossRefs" href="#bib0045">3,4</a> 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%),<a class="elsevierStyleCrossRef" href="#bib0055">5</a> 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).<a class="elsevierStyleCrossRef" href="#bib0060">6</a>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 interestThe authors have no conflicts of interest to declare." 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Aguiar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2017.09.023" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2018" "volumen" => "37" "paginaInicial" => "491" "paginaFinal" => "496" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29779951" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiological clinical characteristics of acute cardiac insufficiency in a tertiary hospital in Lima, Peru" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Pariona" 1 => "P.A. Segura Saldana" 2 => "M. 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Lindmark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ehf2.12251" "Revista" => array:6 [ "tituloSerie" => "ESC Heart Failure" "fecha" => "2018" "volumen" => "5" "paginaInicial" => "337" "paginaFinal" => "343" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29345425" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rationale and design of TRANSITION: a randomized trial of pre-discharge vs. post-discharge initiation of sacubitril/valsartan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Pascual-Figal" 1 => "R. Wachter" 2 => "M. Senni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ehf2.12246" "Revista" => array:6 [ "tituloSerie" => "ESC Heart Failure" "fecha" => "2018" "volumen" => "5" "paginaInicial" => "327" "paginaFinal" => "336" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29239515" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiotensin-neprilysin inhibition in acute decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.J. Velazquez" 1 => "D.A. Morrow" 2 => "A.D. 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Revista Portuguesa de Cardiologia

ISSN: 0870-2551

A Revista Portuguesa de Cardiologia, órgão oficial da Sociedade Portuguesa de Cardiologia, foi fundada em 1982 com o objetivo de informar e formar os cardiologistas portugueses através da publicação de artigos científicos na área da arritmologia, cirurgia cardíaca, cuidados intensivos, doença coronária, ecocardiografia, electrofisiologia, hipertensão arterial, insuficiência cardíaca, métodos de imagem entre outros. Trata-se duma revista mensal de elevada qualidade científica e gráfica, publicada em português e em inglês desde 1999 o que permitiu a sua larga projeção no estrangeiro. É distribuída a todos os sócios da Sociedade Portuguesa de Cardiologia, da Sociedade de Medicina Interna, da Sociedade de Portuguesa de Pneumologia e da Sociedade de Cirurgia Cardiotorácica, bem como a cardiologistas estrangeiros de renome internacional e a quase todas as sociedades congéneres do mundo. É referenciada desde 1987 na Medline e posteriormente no Índex Copernicius.

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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