{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:24:40Z","timestamp":1791818680312,"version":"4.3.4"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Efficacy and tolerability of sacubitril\/valsartan (Sac\/Val) is not well characterized in heart failure (HF) with ejection fraction &gt;40% initiated in\u2010hospital. Thus, this prespecified PARAGLIDE\u2010HF (Prospective Comparison of ARNI With ARB Given Following Stabilization In Decompensated HFpEF) analysis assessed the effects of Sac\/Val versus valsartan (Val) by location of initiation in HF with ejection fraction &gt;40% and recent worsening HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      This analysis of the double\u2010blind, randomized controlled trial assessed patients by in\u2010hospital and out\u2010of\u2010hospital (\u226430\u2009days of worsening HF) initiation. The primary end point was time\u2010averaged proportional change in NT\u2010proBNP (N\u2010terminal pro\u2010B\u2010type natriuretic peptide) from baseline through weeks 4 and 8. A secondary hierarchical outcome consisted of cardiovascular death, HF hospitalizations, urgent HF visits, and NT\u2010proBNP change. Safety end points were symptomatic hypotension, hyperkalemia, and worsening renal function. Overall, 324 (70%, 162 Sac\/Val, 162 Val) were initiated in\u2010hospital and 142 (71 Sac\/Val, 71 Val) out\u2010of\u2010hospital. There was no evidence of a statistically significant differential treatment benefit of Sac\/Val versus Val on NT\u2010proBNP change by location of initiation (in\u2010hospital, 0.86 [95% CI, 0.70\u20131.05] and out\u2010of\u2010hospital, 0.87 [95% CI, 0.70\u20131.09];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.99). The win ratio for the hierarchical outcome was 1.09 (95% CI, 0.82\u20131.45;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.57) for in\u2010hospital and 1.43 (95% CI, 0.91\u20132.26;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.12) for out\u2010of\u2010hospital. For the safety end points of symptomatic hypotension, hyperkalemia, and worsening renal function, no statistically significant differences in tolerability were seen between in\u2010hospital and out\u2010hospital initiation (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      &gt;0.1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Sac\/Val provided consistent benefit compared with Val, whether initiated in\u2010hospital or out\u2010of\u2010hospital in HF with ejection fraction &gt;40% with a recent worsening HF event, demonstrating an opportunity to improve postdischarge outcomes by initiating Sac\/Val during hospitalization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.037899","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T06:37:31Z","timestamp":1739947051000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["In\u2010Hospital or Out\u2010of\u2010Hospital Initiation of Sacubitril\/Valsartan Versus Valsartan in Patients With Mildly Reduced or Preserved Ejection Fraction After A Worsening Heart Failure Event: The PARAGLIDE\u2010HF Trial"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4891-7358","authenticated-orcid":false,"given":"Nina","family":"Nouhravesh","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute","place":["Durham, USA"]},{"name":"Copenhagen University Hospital Herlev and Gentofte","place":["Hellerup, 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Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6145-9814","authenticated-orcid":false,"given":"Shelley","family":"Zieroth","sequence":"additional","affiliation":[{"name":"University of Manitoba","place":["Winnipeg, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3698-9597","authenticated-orcid":false,"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Harvard Medical School","place":["Boston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3222-1719","authenticated-orcid":false,"given":"Robert J.","family":"Mentz","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute","place":["Durham, 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