Real-world comparative effectiveness of sacubitril/valsartan versus RAS inhibition alone in patients with de novo heart failure

IF 3.7 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS ESC Heart Failure Pub Date : 2025-01-30 DOI:10.1002/ehf2.15183

Ankeet S. Bhatt, Muthiah Vaduganathan, Barada P. Jena, Sylwia Suminska, Carlos Eid, Heike Schwende, Michele Senni

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Abstract

Aims

Large-scale, real-world data on early initiation of sacubitril/valsartan in patients newly diagnosed (de novo) with HF with reduced ejection fraction (HFrEF) are limited. We examined the effectiveness of sacubitril/valsartan versus angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) on all-cause and cause-specific hospitalizations among patients with de novo HFrEF from the Optum® dataset in the United States.

Methods

This retrospective cohort study included adult patients with de novo HFrEF (diagnosed ≤30 days) with left ventricular ejection fraction (LVEF) ≤40% who were first prescribed with sacubitril/valsartan or ACEi/ARB from 1 January 2016 to 31 March 2020. The primary endpoint (all-cause hospitalization) and secondary endpoints were analysed in propensity score-matched cohorts.

Results

A cohort of 3290 patients with de novo HFrEF who were prescribed with sacubitril/valsartan and a propensity-matched cohort of 6580 patients who were prescribed with ACEi/ARB were analysed. Overall, the mean (SD) age of patients was 63 (14) years, 34% were women, and baseline characteristics were balanced across treatment groups. Hypertension (67%), diabetes (33%) and chronic kidney disease (28%) were highly prevalent comorbidities. Patients in the sacubitril/valsartan cohort when compared with the ACEi/ARB cohort had lower annual rates of all-cause hospitalizations [incidence rate ratio (IRR): 0.81, 95% confidence interval (CI): 0.75–0.89, P < 0.001], cardiovascular (CV) hospitalizations (IRR: 0.80, 95% CI: 0.73–0.87, P < 0.001) and HF hospitalizations (IRR: 0.86, 95% CI: 0.78–0.95, P = 0.002).

Conclusions

Among patients with de novo HFrEF, sacubitril/valsartan (compared with that of ACEi/ARB) was associated with fewer all-cause, CV and HF hospitalizations. These findings are consistent with clinical trial evidence suggesting potential benefits of early initiation of sacubitril/valsartan in patients with HFrEF, including those soon after diagnosis.

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sacubitril/缬沙坦与单独RAS抑制剂在新发心力衰竭患者中的实际比较效果。

目的：新诊断（de novo） HF伴射血分数降低（HFrEF）患者早期开始使用苏比里尔/缬沙坦的大规模真实数据是有限的。我们从美国的Optum®数据集中研究了sacubitril/缬沙坦与血管紧张素转换酶抑制剂(ACEi)/血管紧张素受体阻滞剂（ARB）对新发HFrEF患者全因和病因特异性住院治疗的有效性。方法：本回顾性队列研究纳入了2016年1月1日至2020年3月31日期间首次服用苏比里尔/缬沙坦或ACEi/ARB的左室射血分数(LVEF)≤40%的成年新生HFrEF（诊断≤30天）患者。主要终点（全因住院）和次要终点在倾向评分匹配的队列中进行分析。结果：我们分析了3290例服用苏比里尔/缬沙坦的新生HFrEF患者和6580例服用ACEi/ARB的倾向匹配患者。总体而言，患者的平均（SD）年龄为63（14）岁，34%为女性，基线特征在治疗组之间是平衡的。高血压（67%）、糖尿病（33%）和慢性肾脏疾病（28%）是非常普遍的合并症。与ACEi/ARB组相比，sacubitril/缬沙坦组患者的年全因住院率更低[发病率比（IRR）： 0.81, 95%可信区间（CI）： 0.75-0.89， P]结论：在新发HFrEF患者中，sacubitril/缬沙坦组（与ACEi/ARB组相比）的全因住院率、CV住院率和HF住院率更低。这些发现与临床试验证据一致，表明对HFrEF患者，包括诊断后不久，早期开始使用苏比里尔/缬沙坦可能有益。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.