Internal medicine

Heart failure

Cardiology

Medicine

European Heart Journal

The year 2014 has become a remarkable year for heart failure. A bad start was caused by the publication of TOPCAT, showing that spironolactone did not prove to be beneficial for the treatment of patients with heart failure and preserved ejection fraction (HFpEF). Nevertheless, further insights in the study yields a few bright spots, and treatment with spironolactone might still be considered in patients with HFpEF. In acute heart failure, additional data were published on the effects of serelaxin. Serelaxin reduced wedge pressures, had similar effects in acute heart failure patients with and without a reduced ejection fraction, and had a neutral effect on diuretic response. But the most important news was related to the results of PARADIGM, where LCZ696, the first-in-class angiotensin-receptor neprilysin inhibitor, proved to be superior to enalapril in reducing mortality and morbidity in patients with heart failure and reduced ejection fraction (HFrEF).During the last decades, treatment of patients with heart failure with reduced ejection fraction (HFrEF) has improved dramatically with the introduction of ACE-inhibitors, β-blockers, angiotensin receptor blockers, and mineralocorticoid receptor antagonists. This caused a stepwise reduction in mortality and heart failure hospitalization. However, residual mortality and morbidity is still too high. Therefore, there is a continuous need for better therapies.The biggest heart failure news of 2014 in heart failure was the presentation and publication of the PARADIGM trial.1 The trial reported the effects of LCZ696, a first in class angiotensin receptor neprilysin inhibitor. LCZ696 comprises the molecular moieties of the angiotensin II AT1 receptor antagonist valsartan and the neprilysin inhibitor prodrug AHU377.2 In PARADIGM, the effect of LCZ696 on a composite of death from cardiovascular causes …

The year in cardiology: heart failure 2014