Held recently in Paris and attended by almost 33,000 delegates from 146 countries, the European Society of Cardiology (ESC) Congress, together with the World Congress of Cardiology, focused on global cardiovascular (CV) health. Its sessions highlighted differences in prevalence, clinical manifestations, prevention strategies, diagnostic modalities and management of CV diseases around the world. Cardiology Today followed five Australian delegates (a cardiology physician, an interventional cardiologist, a cardiology nurse, an endocrinologist/general medicine physician and a GP) attending the congress. We present summaries of some of the late breaking science sessions, attended by three of the delegates, together with their comments on the implications of the findings. Video highlights from all five delegates can be viewed on the Cardiology Today website (https://cardiologytoday.com.au/esc2019videos/day1.html).
PARAGON-HF highlights heterogeneity of heart failure with preserved ejection fraction
Although evidence-based therapies exist for patients with heart failure with reduced ejection fraction (HFrEF), no therapy has been clearly shown to be beneficial in those with heart failure and a preserved ejection fraction (HFpEF). The Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction trial (PARAGON-HF) was a randomised, controlled, industry-funded trial evaluating the clinical efficacy of sacubitrilvalsartan compared with valsartan in 4822 patients with HFpEF (left ventricular ejection fraction [LVEF] 45% or higher) associated with elevated natriuretic peptides and evidence of structural heart disease (LV hypertrophy and/or left atrial dilatation). The trial narrowly missed its primary endpoint, which was a composite of cardiovascular (CV) death and all heart failure hospitalisations (rate ratio, 0.87; 95% confidence interval [CI], 0.75-1.01; p=0.056), which was largely driven by a nonsignificant reduction in total heart failure hospitalisations in the sacubitril – valsartan group (rate ratio, 0.85; 95% CI, 0.72-1.00).