Abstract
Introduction: Real-world 12-month outcomes of sacubitril/valsartan (sac/val) vs. ACEi or ARB use among patients with HFrEF (EF < 40%) through HFpEF (HFmrEF EF 40-49% and HFpEF EF 50-60%) are not well known. A better understanding of hospitalization (hosp), emergency department (ED) visits and mortality provides new information about medication benefits in patients with HF and a wide range of ejection fractions (EF). Methods: Data were retrieved from a multi-state healthcare system database. Patients prescribed sac/val from Aug. 1 2015-Jul. 31 2018 were matched to those on ACEi or ARB based on age, sex, EF, comorbidity status, hospital vs. ambulatory index date reflecting medication use and systolic blood pressure. Twelve-month outcomes based on sac/val vs. ACEi or ARB were assessed using linear, logistic, and Poisson models with generalized estimating equations. Results: Of 3588 patients (1794 per group), mean (SD) age was 64.2 (13.0) years, 70.3% were male, 20.7% were Black, and mean systolic blood pressure was 122.1 (16.1) mmHg. By HF factors, 47.6% were NYHA-FC II and mean EF% was 29.0 (9.9); 349 (9.7%) had HFmrEF or HFpEF. At baseline, 92.4% were on beta-blockers, 43% were on aldosterone antagonists and 63.1% were on loop diuretics. Over 12 months, 125 patients died (38 sac/val vs. 87 ACEi or ARB; p <0.001). Sac/val use was associated with fewer 12-month all-cause and HF hosp, HF ED visits and the composite outcome (all p <0.001); see Figure of adjusted event rate (%) odds ratios. Conclusions: Among patients with HFrEF, HFmrEF and HFpEF (EF up to 60%), use of sac/val was associated with fewer 12-month death and morbidity (all-cause and HF hosp and HF-related ED visits). Patient and provider factors that facilitated sac/val use and improved clinical outcomes should be studied.
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