Critical questions about PARADIGM-HF and the future

Chen Huan Chen*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Cardiovascular (CV) diseases in general and heart failure (HF) in particular are major contributors to death and morbidity and are also recognized as important drivers of health care expenditure. The PARADIGM-HF trial was a pivotal trial designed to compare the long-term effects of LCZ696 with enalapril in patients with symptomatic HF with reduced ejection fraction (HFrEF). This review article presents an in-depth view of the PARADIGM-HF trial and the implications of the results in the management of patients with HF and is based on peer reviewed manuscripts, editorials, perspectives and opinions written about the PARADIGM-HF trial. The article presents the key safety and efficacy results of the trial with specific emphasis on the clinical implications of these findings. The review highlights the highly statistically significant, 20% reduction in the primary composite endpoint of cardiovascular death or HF hospitalization, and a 16% reduction in the risk of death fromany cause. It also provides an overview of the design, clinical findings, limitations and special areas of clinical interest. The review discusses the future of LCZ696 and additional trials that seek to answer questions in other sub-populations of patients with HF. The article reiterates what has been concluded by many experts in the field of HF- the introduction of LCZ696 into routine clinical care,while dependent on the regulatory approvals in various countries as well as acceptance by physicians, payers and patients, will change the treatment landscape for patients with HFrEF.

Original languageEnglish
Pages (from-to)387-396
Number of pages10
JournalActa Cardiologica Sinica
Issue number4
StatePublished - Jul 2016


  • Angiotensin converting enzyme inhibitors
  • ARB
  • Entresto
  • Heart failure
  • LCZ696
  • Neprilysin
  • Reduced ejection fraction


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