Efficacy and safety of sacubitril/valsartan in patients with acute decompensated heart failure: a systematic review and meta-analysis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Sacubitril/Valsartan is the cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF). However, there is limited data on their risk-benefit in patients with acute heart failure requiring hospitalizations. Methods A comprehensive and relevant search of randomized controlled trials (RCT) and cohort studies were conducted examining the use of Sacubitril/Valsaratan in patients hospitalized for heart failure compared to patients using an angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Outcome measures for all-cause mortality, renal worsening function and hyperkalemia were extracted and analyzed using a random effects model via Review Manager V5.4. Results Three studies were included in the meta-analysis with 5,113 subjects analyzed. There was a higher rate of all-cause mortality in the ACE inhibitors/ARBs group, which was statistically significant (RR 0.65 [95%CI: 0.51-0.83], I²=0, p=0.0007). There were no significant differences in worsening renal function (RR 0.91 [95%CI: 0.78-1.06], I²=0, p=0.24) and hyperkalemia (RR 1.04 [95%CI: 0.78-1.37], I²=0, p=0.81) between Sacubitril/Valsartan and ACEi/ARB groups. Conclusion Sacubitril/Valsartan and ACE inhibitors/ARBs have similar rates of worsening renal function and hyperkalemia among heart failure patients in acute decompensation. However, ACE inhibitors/ARBs had a higher incidence of all-cause mortality, which suggests Sacubitril/Valsartan may be a preferable heart failure regimen in patients with acute decompensated heart failure.