Sacubitril/valsartan effective in HFrEF patients with concurrent renal impairment, hypotension
In heart failure patients with reduced ejection fraction (HFrEF) and renal impairment or hypotension, sacubitril/valsartan has been shown to be an effective angiotensin receptor and neprilysin inhibition (ARNI) intervention, reports a recent study.
The investigators included adult HFrEF patients undergoing standard HF treatment with (group A; n=466; mean age, 61.3±14.5 years; 75.3 percent male) and without (group B; n=466; mean age, 62.2±15.3 years; 73.4 percent male) sacubitril/valsartan. Primary outcomes included death from cardiovascular causes or a first unpanned HF hospitalization.
The primary outcomes occurred in 100 patients in group A, resulting in an incidence rate of 21.5 percent. This was significantly lower than that in group B (n=144; 30.9 percent; hazard ratio [HR], 0.66, 95 percent CI, 0.51–0.85; p=0.001).
Further disaggregation revealed that 31 (6.7 percent) of the incident cases in group A were deaths due to cardiovascular causes. The corresponding figure in group B was 59 (12.7 percent), which similarly resulted in a statistically significant difference in risk (HR, 0.50, 0.33–0.78; p=0.002). Deaths from all causes were likewise more common in group B (16.7 percent vs 9.2 percent; HR, 0.53, 0.36–0.77; p=0.001).
In group A, 87 patients (18.7 percent) had to be hospitalized for HF, as opposed to 132 (28.3 percent) in group B (HR, 0.62, 0.48–0.82; p<0.001), due to the consistent effect of the ARNI treatment in preventing first HF hospitalization or rehospitalization.