Clinical outcomes of sacubitril-valsartan versus angiotensin converting enzyme inhibitor or angiotensin receptor blocker among patients with heart failure and ejection fraction at/less than 60 %: A retrospective, observational, parallel cohort, multi-group study.

BACKGROUND

Real-world heart failure (HF) and all-cause hospitalization, HF-related emergency care visits, all-cause mortality and the composite of all-cause or HF hospitalization or HF-related emergency visit remain high, due to underuse of core HF medications.

OBJECTIVES

A better understanding of real-world clinical outcomes is needed based on sacubitril-valsartan vs. angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) use among patients with HF and a wide range of ejection fractions.

METHODS

Data retrieved from a multi-center, multi-state healthcare system database of patients prescribed sacubitril-valsartan were matched to those on ACEI/ARB based on age, sex, EF, comorbidity status, systolic blood pressure and index date site (hospital or ambulatory). Six- and 12-month outcomes based on sacubitril-valsartan vs. ACEI/ARB were assessed using linear, logistic, and Poisson models with generalized estimating equations.

RESULTS

Patients (N = 4188; 2094/cohort) were well matched based on characteristics; 29.8 % were female, mean (SD) age was 64.3 (13.1) years, systolic blood pressure was 122.0 (16.2) mmHg, EF% was 29.1 (9.9); nearly half were in NYHA FC II and 422 (10.1 %) had EF of 41-60 %. Frequency of non-study medications at baseline was 92.6 % beta-blocker, 43.2 % mineralocorticoid receptor antagonist and 64.2 % loop diuretic. Compared to ACEI/ARB, all 6 and 12-month clinical outcomes were improved among patients using sacubitril-valsartan (all 12-month p<.001).

CONCLUSIONS

Among patients with HF and EF up to 60 %, sacubitril-valsartan use was associated with lower 12-month morbidity and mortality. Providers and clinicians need to advocate for use of sacubitril-valsartan per hierarchical renin angiotensin system inhibitor national guideline recommendations.