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Comparative Effectiveness of Sacubitril-Valsartan Versus ACE/ARB Therapy in Heart Failure With Reduced Ejection

Nicholas Y Tan1, Lindsey R Sangaralingham2, S Jeson Sangaralingham1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.

JACC. Heart Failure
|December 16, 2019
PubMed

Insights

Sacubitril-valsartan use in systolic heart failure (HF) patients showed reduced risks of death and hospitalization compared to ACE/ARB. However, similar outcomes were observed in Black patients, warranting further investigation.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • The PARADIGM-HF trial demonstrated sacubitril-valsartan's superiority over enalapril in reducing mortality and HF hospitalizations.
  • Real-world comparative effectiveness of sacubitril-valsartan versus ACE/ARB in systolic heart failure (HF) remains unclear.

Purpose of the Study:

  • To compare the effectiveness of sacubitril-valsartan against angiotensin-converting enzyme inhibitors (ACE)/angiotensin receptor blockers (ARB) in patients with systolic HF in a real-world setting.
  • To evaluate risks of mortality and hospitalization associated with sacubitril-valsartan versus ACE/ARB treatments.

Main Methods:

  • Utilized a U.S. administrative claims database to identify patients with systolic HF treated between July 2015 and February 2018.
  • Employed one-to-one propensity score matching on 29 clinical variables to create balanced cohorts for sacubitril-valsartan and ACE/ARB users.
  • Applied Cox models to compare all-cause mortality, all-cause hospitalization, and HF hospitalization between the two treatment groups.

Main Results:

  • Analysis included 7,893 matched pairs with a mean follow-up of 6.3 months.
  • Sacubitril-valsartan was associated with significantly lower risks of all-cause mortality (HR: 0.80) and all-cause hospitalization (HR: 0.86) compared to ACE/ARB.
  • No significant difference in HF hospitalization was observed (HR: 1.07), and a reduced risk of the primary outcome was noted in White patients but not in Black patients (interaction p=0.032).

Conclusions:

  • Sacubitril-valsartan demonstrated reduced risks of death and hospitalization in a diverse systolic HF patient cohort compared to ACE/ARB.
  • The similar outcomes observed between sacubitril-valsartan and ACE/ARB in Black patients necessitate further research and evaluation.
  • Findings suggest potential differential treatment effects based on race, highlighting the need for personalized approaches in HF management.
Abstract

Keywords:
heart failurehospitalizationmedicationmortalitysacubitril-valsartan

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