Heart Failure: Future Directions

Heart Failure: Future Directions Marc A. Pfeffer, MD, PhD Dzau Professor of Medicine, Harvard Medical School Cardiovascular Division, Brigham & Women’...
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Heart Failure: Future Directions Marc A. Pfeffer, MD, PhD Dzau Professor of Medicine, Harvard Medical School Cardiovascular Division, Brigham & Women’s Hospital Boston, Massachusetts

Disclosures: Marc A. Pfeffer, M.D., Ph.D., reports having serves as consultant to Aastrom, Abbott Vascular, Amgen, Cleveland Clinic, Concert, Daiichi Sankyo, Fibrogen, Genzyme, GlaxoSmithKline, Hamilton Health Sciences, Medtronic, Merck, Novartis, Novo Nordisk, Roche, Salix, Sanderling, Sanofi Aventis, Servier, and Teva and having received grant support from Amgen, Celladon, Novartis, and Sanofi­Aventis. The Brigham and Women’s Hospital has patents for the use of inhibitors of the renin­angiotensin system in survivors of MI with Novartis. Dr. Pfeffer’s shares are irrevocably transferred to charity.

Timeline of Landmark Heart Failure RCTs 1990

V­HeFT CONSENSUS

1995

SOLVD SAVE

2000

2005

2010

COPERNICUS CARE­HF RALES Val­HeFT SCD­HeFT CIBIS­2 CHARM HeartMate II MERIT­HF EPHESUS MADIT­CRT COMPANION

SHIFT RAFT EMPHASIS

We need a bigger pole!

2014 PARADIGM-HF: Cardiovascular Death or Heart Failure Hospitalization (Primary Endpoint)

Kaplan­Meier Estimate of Cumulative Rates (%)

40

Enalapril

32

(n=4212)

914

24

LCZ696 (n=4187)

16

HR = 0.80 (0.73­0.87) P = 0.0000002 Number needed to treat = 21

8 0

0

180

360

540

720

900

1080

1260

896 853

249 236

Days After Randomization

Patients at Risk LCZ696 Enalapril

1117

4187 4212

3922 3883

3663 3579

3018 2922

2257 2123

1544 1488

PARADIGM-HF: All-Cause Mortality 2014

Kaplan­Meier Estimate of Cumulative Rates (%)

32

Enalapril

HR = 0.84 (0.76­0.93) P