But those people with heart failure and ejection fraction below normal seem to be getting some benefit from sacubitril/valsartan, from another drug called candesartan, and from mineralocorticoid receptor antagonists, like spironolactone and eplerenone.
In other words, what we were seeing was that there was another drug that seemed to be effective in patients who have what we would today call heart failure with midrange ejection fraction: patients with an ejection fraction that’s certainly not normal it’s below normal, but it’s not in the HFrEF range. It was driven, as you would expect, by around a 15% reduction in heart failure hospitalization, but the interesting thing was that that benefit was concentrated in patients with an ejection fraction below the median value in the trial, which was 57%.
05, so the trial was not technically statistically significant, although if we added a few worsening heart failure events that needed emergency treatment but didn’t lead to hospital admission, that made the overall treatment effect significant, so it was borderline. The PARAGON-HF trial overall showed a borderline effect with sacubitril/valsartan on the primary composite outcome of cardiovascular death and heart failure hospitalizations. John McMurray, MBChB: The most recent attempt to identify treatments for patients with heart failure and preserved ejection fraction was with sacubitril/valsartan and the PARAGON-HF trial, which was the sister trial to PARADIGM-HF, which was the heart failure in reduced ejection fractions, sacubitril/valsartan trial.