{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T22:50:47Z","timestamp":1768517447122,"version":"3.49.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"British Heart Foundation Centre of Research Excellence","award":["RE\/18\/6\/34217"],"award-info":[{"award-number":["RE\/18\/6\/34217"]}]},{"name":"Vera Melrose Heart Failure Research Fund"},{"name":"PARADIGM-HF"},{"name":"PARAGON-HF"},{"DOI":"10.13039\/100020604","name":"Novartis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020604","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate the EQ-5D-3L Level Sum Score (LSS) in patients with heart failure (HF) and reduced (HFrEF) and mildly reduced or preserved ejection fraction (HFmrEF\/HFpEF) and the effect of sacubitril\/valsartan on this score using patient-level data from the PARADIGM-HF and PARAGON-HF trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>The LSS was calculated by summing the three levels (1\u20133) for each of the five domains (minimum sum score = 5; maximum sum score = 15). Patient characteristics and outcomes were compared across LSS tertiles (T1\u2013T3) at baseline. Cox models were used to evaluate the primary endpoint [first HF hospitalization or cardiovascular death (CVD)] according to tertiles of LSS. Changes in LSS severity at 8 months were analysed using ordinal logistic regression models to estimate the effect of sacubitril\/valsartan vs. enalapril or valsartan. Of 13 195 patients, 12 974 had a baseline LSS. Compared to lower LSS, patients with higher (worse) scores were older, more often women and White, and had more comorbidities and more severe HF. At 8 months, patients assigned to sacubitril\/valsartan experienced more improvement and less worsening of LSS vs. the comparator: OR:1.16 (95%CI: 1.08\u20131.24). Sacubitril\/valsartan also reduced the risk of the primary outcome across LSS tertiles: T1: HR: 0.87 (95%CI: 0.75\u20131.00); T2: 0.80 (95%CI: 0.71\u20130.90); T3: 0.87 (95%CI: 0.77\u20130.97); Pinteraction = 0.59. Higher LSS was independently associated with a greater risk of the primary endpoint, and the achieved LSS at 8 months may be more strongly associated with subsequent outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sacubitril\/valsartan significantly reduced the risk of HF events and improved health status across the LSS spectrum in HFrEF and HFmrEF\/HFpEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>https:\/\/www.clinicaltrials.gov. Unique identifiers: NCT01920711 (PARAGON-HF), NCT01035255 (PARADIGM-HF).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcvp\/pvaf064","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T11:52:28Z","timestamp":1755777148000},"page":"574-589","source":"Crossref","is-referenced-by-count":1,"title":["Sacubitril\/valsartan and quality of life assessed using the EuroQol Five-dimension Three-level questionnaire level sum score (EQ-5D-3L-LSS) in patients with HFrEF and HFmrEF\/HFpEF"],"prefix":"10.1093","volume":"11","author":[{"given":"Mingming","family":"Yang","sequence":"first","affiliation":[{"name":"British Heart Foundation Cardiovascular Research Centre, University of Glasgow , 126 University Place, Glasgow G12 8TA ,","place":["UK"]},{"name":"Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University , Nanjing 210009 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alasdair 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P","family":"Lam","sequence":"additional","affiliation":[{"name":"National Heart Centre Singapore & Duke-National University of Singapore \u00a0 169609 ,","place":["Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aldo P","family":"Maggioni","sequence":"additional","affiliation":[{"name":"ANMCO Research Center, Heart Care Foundation , Florence 50121 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe A","family":"Martinez","sequence":"additional","affiliation":[{"name":"Universidad Nacional de C\u00f3rdoba , C\u00f3rdoba X5000 ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean L","family":"Rouleau","sequence":"additional","affiliation":[{"name":"Institut de Cardiologie de Montr\u00e9al, Universit\u00e9 de Montr\u00e9al , Montr\u00e9al H1T 1C8 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Swedberg","sequence":"additional","affiliation":[{"name":"Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg 40530 ,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0885-1953","authenticated-orcid":false,"given":"Muthiah","family":"Vaduganathan","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk J","family":"van Veldhuisen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Thorax Center, University Medical Center , Postbus 30.001, 9700 RB Groningen ,","place":["the Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7456-1570","authenticated-orcid":false,"given":"Faiez","family":"Zannad","sequence":"additional","affiliation":[{"name":"Inserm Clinical Investigation Centre, CHU, Universit\u00e9 de Lorraine , Nancy 54500 ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael R","family":"Zile","sequence":"additional","affiliation":[{"name":"RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina , Charleston, SC 29401 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1828-2387","authenticated-orcid":false,"given":"Milton","family":"Packer","sequence":"additional","affiliation":[{"name":"Baylor Heart and Vascular Institute, Baylor University Medical Center , Dallas, TX 75226 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adel","family":"Rizkala","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceuticals Corporation , East Hanover, NJ 07936 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eldrin F","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford University , Palo Alto, CA 94305 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pardeep S","family":"Jhund","sequence":"additional","affiliation":[{"name":"British Heart Foundation Cardiovascular Research Centre, University of Glasgow , 126 University Place, Glasgow G12 8TA ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott D","family":"Solomon","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital, Harvard 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