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Vol. 38. Núm. 2.
Páginas 73-170 (Fevereiro 2019)
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Vol. 38. Núm. 2.
Páginas 73-170 (Fevereiro 2019)
Letter to the Editor
DOI: 10.1016/j.repc.2019.02.001
Open Access
Response to the Letter to the Editor – “The PARADIGM-HF population may be very different from real-world heart failure patients”
Resposta à Carta ao Editor «A população do PARADIGM-HF pode ser muito diferente do mundo real dos doentes com insuficiência cardíaca»
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Gustavo Rodrigues
Autor para correspondência
gustavo_rodrigues17@hotmail.com

Corresponding author.
, António Tralhão, Carlos Aguiar, Pedro Freitas, António Ventosa, Miguel Mendes
Hospital de Santa Cruz, CHLO, Lisbon, Portugal
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To the Editor:

As highlighted by our analysis,1 the epidemiological study in Lima2 pertinently quoted by Walter Calderón, and another two large registries,3,4 patients from randomized trials are frequently different from those found in our daily practice. However, the results of the PARADIGM-HF trial are changing and will continue to change the way we treat patients with heart failure and reduced ejection fraction.

Recently, the TRANSITION trial demonstrated the safety of sacubitril/valsartan when initiated prior to discharge from hospitalization for heart failure, achieving similar titration rates (62% vs. 68%),5 and PIONEER-HF showed that in-hospital initiation of sacubitril/valsartan further reduced NT-proBNP values (ratio of NT-proBNP at week 4 and 8 to baseline value: 0.53 vs. 0.75).6

Concluding, different pieces of an intricate puzzle are coming together, contributing to the widespread adoption of neuromodulation in patients with heart failure and reduced ejection fraction.

Conflicts of interest

The authors have no conflicts of interest to declare.

References
[1]
G. Rodrigues, A. Tralhao, C. Aguiar, et al.
Is the PARADIGM-HF cohort representative of the real-world heart failure patient population?.
Rev Port Cardiol, 37 (2018), pp. 491-496
[2]
M. Pariona, P.A. Segura Saldana, M. Padilla Reyes, et al.
Epidemiological clinical characteristics of acute cardiac insufficiency in a tertiary hospital in Lima, Peru.
Rev Peru Med Exp Sal Publ, 34 (2017), pp. 655-659
[3]
P. Pellicori, A. Urbinati, P. Shah, et al.
What proportion of patients with chronic heart failure are eligible for sacubitril-valsartan?.
Eur J Heart Failure, 19 (2017), pp. 768-778
[4]
H. Norberg, E. Bergdahl, K. Lindmark.
Eligibility of sacubitril-valsartan in a real-world heart failure population: a community-based single-centre study.
ESC Heart Failure, 5 (2018), pp. 337-343
[5]
D. Pascual-Figal, R. Wachter, M. Senni, et al.
Rationale and design of TRANSITION: a randomized trial of pre-discharge vs. post-discharge initiation of sacubitril/valsartan.
ESC Heart Failure, 5 (2018), pp. 327-336
[6]
E.J. Velazquez, D.A. Morrow, A.D. DeVore, et al.
Angiotensin-neprilysin inhibition in acute decompensated heart failure.
Copyright © 2019. Sociedade Portuguesa de Cardiologia
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