Impact of sacubitril/valsartan on adverse clinical events in heart failure with end-stage renal disease patients-a real life nationwide investigation.

The research aims at identifying the risk of adverse events, including acute myocardial infarction (AMI) readmission, heart failure (HF) readmission, and cardiovascular (CV) death induced by sacubitril/valsartan in patients with end-stage renal disease (ESRD) and HF. This data came from the Taiwan National Health Insurance Research Database (NHIRD). Propensity scoring (PS) matching was used. Cox proportional hazard model was applied to calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse events among the study groups. After propensity score matching, among HF + ESRD patients, 854 received sacubitril/valsartan, and the other 854 patients did not. Compared to patients who did not receive sacubitril/valsartan, patients with sacubitril/valsartan were more likely to suffer AMI readmission (aHR = 1.85, 95% CI = 1.42-2.41), HF readmission (aHR = 2.21, 95% CI = 1.93-2.55), and CV death (aHR = 1.65, 95% CI = 1.28-2.12) after matching. Patients who received sacubitril/valsartan for less than 75 days had a greater risk of AMI readmission (aHR = 2.83, 95% CI = 2.27-3.53), HF readmission (aHR = 5.36, 95% CI = 4.75-6.06), and CV death (aHR = 2.27, 95% CI = 1.81-2.85) than non-sacubitril/valsartan cohorts. However, when the patients received sacubitril/valsartan for ≥ 185 days, they had a trend toward a lower risk of AMI readmission (aHR = 0.66, 95% CI = 0.41-1.04), HF readmission (aHR = 0.84, 95% CI = 0.68-1.03), and CV death (aHR = 0.83, 95% CI = 0.55-1.24) than the non-sacubitril/valsartan cohort, although it did not reach statistical significance. This study highlights significant risks associated with sacubitril/valsartan, particularly in the short term, and the protective effect of prolonged use of sacubitril/valsartan in HF + ESRD patients.