ACC 2019—Sacubitril/valsartan shows benefit over enalapril in acute HF


  • Caleb Rans, PharmD
  • Conference Reports
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Takeaway

  • Results from an extension study showed that starting sacubitril/valsartan as opposed to enalapril during hospital stay improved clinical outcomes in stabilized patients with acute decompensated heart failure and reduced ejection fraction (HFrEF).

Why this matters

  • The novel strategy has the potential to improve postdischarge outcomes.

Study design

  • A 4-week open-label extension study of the PIONEER-HF trial, which evaluated sacubitril/valsartan vs enalapril at 8 weeks postdischarge in 881 patients with HFrEF and recent hospitalization for acute decompensated HF.
  • All participants received sacubitril/valsartan.
  • The primary endpoints were change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and a composite endpoint (death, HF hospitalization, or left ventricular assist device implantation) at 12 weeks postdischarge.
  • Funding: Novartis.

Key results

  • Switching from enalapril to sacubitril/valsartan at 8 weeks resulted in a further 35.8% reduction in NT-proBNP at 12 weeks postdischarge (P<.0001>
  • Initiation of sacubitril/valsartan during hospital stay reduced the risk for the composite endpoint over 12 weeks vs starting enalapril in hospital and switching to sacubitril/valsartan at 8 weeks (HR, 0.67; P=.02).

    Limitations

    • Short duration of follow-up.

    Expert comment

    • "We think these data have important clinical implications. While sacubitril-valsartan decreases NT-proBNP compared with enalapril regardless of when it is initiated, the early improvement in postdischarge outcomes supports the in-hospital initiation of sacubitril-valsartan in stabilized patients with acute decompensated heart failure," said Adam DeVore, MD, MHS, assistant professor of medicine at the Duke Clinical Research Institute, Durham. He was not a participant in the trial.