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