New Therapy Could Substantially Reduce Heart Failure Deaths

A substantial number of deaths in the United States could be prevented by optimal implementation of angiotensin receptor neprilysin inhibition (ARNI) therapy, according to a new study.

“The magnitude of the impact that optimal implementation of this one therapy could have on the health of heart failure patients was a surprise,” said study lead author Gregg C. Fonarow, MD, director of the Ahmanson-UCLA Cardiomyopathy Center and co-chief of the UCLA Division of Cardiology in Los Angeles, California.
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The researchers sought to quantify the projected gains for deaths prevented or postponed with comprehensive implementation of ARNI therapy for patients with heart failure and reduced ejection fraction (HFrEF) in the United States.

They obtained from published sources eligibility criteria for ARNI therapy, population-based estimates of patients with HFrEF in the United States, and numbers needed to treat to overt death. The potential numbers of deaths prevented or postponed as a result of ARNI were estimated along with multiple-way sensitivity analysis.

The investigators projected 2,287,296 of 2,736,000 patients (84%) with HFrEF in the United States to be candidates for ARNI therapy. They empirically estimated optimal implementation of ARNI therapy to prevent 28,484 deaths a year (range, 18,230-41,017 deaths per year).

“These findings support efforts to ensure timely implementation of evidence and guidelines into clinical practice as this will have a material impact on the health and outcomes among patients with heart failure,” Dr Fonarow said.

They plan further research to evaluate the real-world clinical effectiveness of this therapy, with a focus on types of patients not well represented in the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial, he said.

—Mike Bederka

Reference:

Fonarow GC, Hernandez AF, Solomon SD, Yancy CW. Potential mortality reduction with optimal implementation of angiotensin receptor neprilysin inhibitor therapy in heart failure [published online June 22, 2016]. JAMA Cardiol. doi:10.1001/jamacardio.2016.1724.