Sacubitril/valsartan in heart failure with reduced ejection fraction patients: Real world experience on advanced chronic kidney disease, hypotension, and dose escalation

J Cardiol. 2019 Oct;74(4):372-380. doi: 10.1016/j.jjcc.2019.03.010. Epub 2019 Apr 11.

Abstract

Background: Angiotensin receptor and neprilysin inhibition (ARNI) has been shown to reduce cardiovascular mortality by 20% as compared with enalapril in a randomized controlled trial. However, there is a paucity of real-world data on the effects of ARNI in heart failure patients with reduced ejection fraction (HFrEF), especially those with concurrent renal impairment or hypotension.

Methods: Between 2016 and 2017, we recruited 466 HFrEF patients treated with sacubitril/valsartan (Group A) and 466 patients managed with standard HF treatment without ARNI (Group B) in a HF referral center. Baseline characteristics and clinical outcomes were collected between both groups.

Results: Baseline characteristics were comparable between the two groups. During a follow-up period of 15 months, death from cardiovascular causes or first unplanned hospitalization for HF occurred in 100 patients in Group A (21.5%) and 144 in Group B (30.9%, hazard ratio 0.66; 95% CI 0.51-0.85; p=0.001). The incidences of deaths from any causes, cardiovascular death, sudden death, and HF re-hospitalization were all significantly lower in Group A than Group B patients. Among patients with different chronic kidney disease stages and normotensive patients, treatment with sacubitril/valsartan showed more favorable outcomes than treatment with standard HF care without ARNI. However, in patients with baseline systolic blood pressure lower than 100mmHg, there were no significant differences of outcomes in both groups. Among Group A patients, escalation of sacubitril/valsartan was associated with better outcomes.

Conclusions: Our study demonstrated the effectiveness of sacubitril/valsartan on HFrEF patients in real world practice, including those with advanced renal impairment.

Keywords: Chronic kidney disease; Heart failure; Sacubitril/valsartan.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aminobutyrates / administration & dosage*
  • Angiotensin Receptor Antagonists / administration & dosage*
  • Biphenyl Compounds
  • Blood Pressure / drug effects
  • Dose-Response Relationship, Drug
  • Drug Combinations
  • Female
  • Heart Failure / complications
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Hospitalization
  • Humans
  • Hypotension / complications
  • Hypotension / physiopathology*
  • Male
  • Middle Aged
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / physiopathology*
  • Stroke Volume / drug effects
  • Tetrazoles / administration & dosage*
  • Treatment Outcome
  • Valsartan

Substances

  • Aminobutyrates
  • Angiotensin Receptor Antagonists
  • Biphenyl Compounds
  • Drug Combinations
  • Tetrazoles
  • Valsartan
  • sacubitril and valsartan sodium hydrate drug combination