Baseline Characteristics of Patients With Heart Failure and Preserved Ejection Fraction in the PARAGON-HF Trial.

Abstract

BACKGROUND:

To describe the baseline characteristics of patients with heart failure and preserved left ventricular ejection fraction enrolled in the PARAGON-HF trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in HFpEF) comparing sacubitril/valsartan to valsartan in reducing morbidity and mortality.

METHODS AND RESULTS:

We report key demographic, clinical, and laboratory findings, and baseline therapies, of 4822 patients randomized in PARAGON-HF, grouped by factors that influence criteria for study inclusion. We further compared baseline characteristics of patients enrolled in PARAGON-HF with those patients enrolled in other recent trials of heart failure with preserved ejection fraction (HFpEF). Among patients enrolled from various regions (16% Asia-Pacific, 37% Central Europe, 7% Latin America, 12% North America, 28% Western Europe), the mean age of patients enrolled in PARAGON-HF was 72.7±8.4 years, 52% of patients were female, and mean left ventricular ejection fraction was 57.5%, similar to other trials of HFpEF. Most patients were in New York Heart Association class II, and 38% had ≥1 hospitalizations for heart failure within the previous 9 months. Diabetes mellitus (43%) and chronic kidney disease (47%) were more prevalent than in previous trials of HFpEF. Many patients were prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (85%), β-blockers (80%), calcium channel blockers (36%), and mineralocorticoid receptor antagonists (24%). As specified in the protocol, virtually all patients were on diuretics, had elevated plasma concentrations of N-terminal pro-B-type natriuretic peptide (median, 911 pg/mL; interquartile range, 464-1610), and structural heart disease.

CONCLUSIONS:

PARAGON-HF represents a contemporary group of patients with HFpEF with similar age and sex distribution compared with prior HFpEF trials but higher prevalence of comorbidities. These findings provide insights into the impact of inclusion criteria on, and regional variation in, HFpEF patient characteristics.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT01920711.

• Authors: Scott D Solomon, Adel R Rizkala, Martin P Lefkowitz, Victor C Shi, JianJian Gong, Nagesh Anavekar, Stefan D Anker, Juan L Arango, Jose L Arenas, Dan Atar, Turia Ben-Gal, Sergey A Boytsov, Chen-Huan Chen, Vijay K Chopra, John Cleland, Josep Comin-Colet, Hans-Dirk Duengen, Luis E Echeverría Correa, Gerasimos Filippatos, Andreas J Flammer, Michel Galinier, Armando Godoy, Eva Goncalvesova, Stefan Janssens, Tzvetana Katova, Lars Køber, Małgorzata Lelonek, Gerard Linssen, Lars H Lund, Eileen O'Meara, Béla Merkely, Davor Milicic, Byung-Hee Oh, Sergio V Perrone, Naresh Ranjith, Yoshihiko Saito, Jose F Saraiva, Sanjiv Shah, Petar M Seferovic, Michele Senni, Antonio S Sibulo Jr, David Sim, Nancy K Sweitzer, Jyrki Taurio, Dragos Vinereanu, Bojan Vrtovec, Jiří Widimský Jr, Mehmet B Yilmaz, Jingmin Zhou, Robert Zweiker, Inder S Anand, Junbo Ge, Carolyn S P Lam, Aldo P Maggioni, Felipe Martinez, Milton Packer, Marc A Pfeffer, Burkert Pieske, Margaret M Redfield, Jean L Rouleau, Dirk J Van Veldhuisen, Faiez Zannad, Michael R Zile, John J V McMurray
• Journal: Circulation. Heart failure (Circ Heart Fail) Vol. 11 Issue 7 Pg. e004962 (07 2018) ISSN: 1941-3297 [Electronic] United States
• PMID: 29980595 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 American Heart Association, Inc.

Chemical References

• Adrenergic beta-Antagonists
• Angiotensin II Type 1 Receptor Blockers
• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Mineralocorticoid Receptor Antagonists
• Valsartan

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Aged
• Aged, 80 and over
• Angiotensin II Type 1 Receptor Blockers (therapeutic use)
• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Clinical Trials as Topic
• Female
• Heart Failure (drug therapy, physiopathology)
• Humans
• Male
• Middle Aged
• Mineralocorticoid Receptor Antagonists (therapeutic use)
• Stroke Volume (drug effects)
• Valsartan (therapeutic use)
• Ventricular Function, Left (drug effects)