PARADIGM-HF trial: will LCZ696 change the current treatment of systolic heart failure?

Heart failure (HF) is a global health problem with an estimated prevalence of over 5.8 million in the USA and over 23 million worldwide.[1] It represents the most common cause of hospitalization in elderly patients (≥ 65 years) and its incidence has a growing trend mainly due to the aging of the population.[2] Neurohumoral activation plays a major role in the pathophysiology.[3] So in consequence, the cornerstone of its medical treatment is based on the inhibition of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system.[2] According to this, all patients with HF and reduced ejection fraction should be treated with an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) plus a beta blocker (BB) and if needed, a mineralocorticoid receptor antagonist (MRA).[2]