Abstract
BackgroundThe effectiveness and safety of initiating sacubitril/valsartan therapy among patients who are hospitalized for acute heart failure (HF) is unclear.MethodsA cohort of 3736 patients with HF with reduced ejection fraction (HFrEF) hospitalized for acute HF was identified from Chang Gung Research Database between January 1, 2016 and August 31, 2019. The risks of rehospitalization for HF and death associated with sacubitril/valsartan therapy compared to angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) therapy were evaluated. We used stabilized inverse probability of treatment weighting to balance the baseline covariates. The risks of fatal and non-fatal outcomes between the groups were compared using a Cox proportional hazard model and Fine and Gray subdistribution hazard model, respectively.FindingsThe composite of rehospitalization for HF and death occurred in 22.9% of the patients in the sacubitril/valsartan group compared to 32.6% in the ACEI/ARB group (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.52–0.97) after a mean follow-up period of 11.8 months. The sacubitril/valsartan group had a lower risk of rehospitalization for HF (subdistribution HR 0.83, 95% CI 0.74–0.92) and all-cause death (HR 0.51, 95% CI 0.27–0.94). There were no significant differences in the rates of worsening renal function or severe hyperkalemia between the two groups.InterpretationIn real-world practice, initiating sacubitril/valsartan therapy among patients with HFrEF who were hospitalized for acute HF was associated with a lower rate of rehospitalization for HF and death compared with ACEI/ARB therapy.FundingThis study was supported by Novartis Pharmaceuticals.
Highlights
Hospitalized patients with acute heart failure (HF) are at a high risk of poor outcomes, including high inpatient mortality, frequent rehospitalizations for worsening HF and death in the vulnerable post-discharge period [1,2]
Initiating sacubitril/valsartan therapy among patients with HF with reduced ejection fraction (HFrEF) who were hospitalized for acute HF was associated with a lower rate of rehospitalization for HF and death compared with angiotensinconverting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARB) therapy after a mean follow-up period of 11.8 months
No significant differences were found in the cumulative incidence rates of rehospitalization for HF or death between the ACEI and ARB groups. In this real-world cohort study, we evaluated the effectiveness and safety associated with initiating sacubitril/valsartan treatment compared to ACEI/ARB treatment in patients with HFrEF during the high-risk transition period following acute HF hospitalization
Summary
Hospitalized patients with acute heart failure (HF) are at a high risk of poor outcomes, including high inpatient mortality, frequent rehospitalizations for worsening HF and death in the vulnerable post-discharge period [1,2]. The PIONEER-HF trial demonstrated that, compared with angiotensin-converting enzyme inhibitor (ACEI) enalapril, initiating sacubitril/valsartan treatment among patients with hospitalization for acute heart failure (HF) resulted in a lower composite of rehospitalization for HF and cardiovascular death over a short period of 8 weeks. Initiating sacubitril/valsartan therapy among patients with HF with reduced ejection fraction (HFrEF) who were hospitalized for acute HF was associated with a lower rate of rehospitalization for HF and death compared with ACEI/ angiotensin II receptor blocker (ARB) therapy after a mean follow-up period of 11.8 months. Interpretation: In real-world practice, initiating sacubitril/valsartan therapy among patients with HFrEF who were hospitalized for acute HF was associated with a lower rate of rehospitalization for HF and death compared with ACEI/ARB therapy.
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