Sacubitril/Valsartan in Patients Hospitalized With Decompensated Heart Failure

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Efficacy and safety of sacubitril/valsartan in hospitalized heart failure (HF) patients across the left ventricular ejection fraction (EF) spectrum were previously undescribed.
• Heart failure management requires understanding treatment effects across diverse EF ranges.

Purpose of the Study:

• To pool data from PIONEER-HF and PARAGLIDE-HF randomized trials to evaluate sacubitril/valsartan's treatment effect across the EF spectrum in patients hospitalized for worsening heart failure (WHF).
• To assess the impact of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and clinical outcomes.

Main Methods:

• Pooled analysis of two double-blind, randomized trials (PIONEER-HF and PARAGLIDE-HF) comparing sacubitril/valsartan with control therapy (enalapril or valsartan).
• Patients were enrolled during hospitalization for HF or within 30 days of a WHF event.
• Primary endpoint was time-averaged proportional change in NT-proBNP; clinical endpoints were analyzed through follow-up.

Main Results:

• The pooled analysis included 1,347 patients, with a median EF of 30%.
• Sacubitril/valsartan demonstrated a 24% greater reduction in NT-proBNP compared to control therapy (P < 0.0001).
• Cardiovascular death or HF hospitalization was reduced by 30% (HR: 0.70; P = 0.0077), consistent across EF ≤60%. Symptomatic hypotension risk increased (RR: 1.35).

Conclusions:

• In patients stabilized after WHF, sacubitril/valsartan significantly reduced NT-proBNP and improved clinical outcomes compared to control therapy.
• These benefits were particularly evident across the spectrum of EF ≤60%.
• Sacubitril/valsartan is an effective treatment option for hospitalized HF patients across a broad EF range.