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Clinical Effectiveness of Sacubitril/Valsartan Among Patients Hospitalized for Heart Failure With Reduced Ejection Fraction.
Greene SJ, Choi S, Lippmann SJ, Mentz RJ, Greiner MA, Hardy NC, Hammill BG, Luo N, Samsky MD, Heidenreich PA, Laskey WK, Yancy CW, Peterson PN, Curtis LH, Hernandez AF, Fonarow GC, O'Brien EC. Clinical Effectiveness of Sacubitril/Valsartan Among Patients Hospitalized for Heart Failure With Reduced Ejection Fraction. Journal of the American Heart Association. 2021 Aug 17; 10(16):e021459.
Background Sacubitril/Valsartan has been highly efficacious in randomized trials of heart failure with reduced ejection fraction (HFrEF). However, the effectiveness of sacubitril/valsartan in older patients hospitalized for HFrEF in real-world US practice is unclear. Methods and Results This study included Medicare beneficiaries age 65 years who were hospitalized for HFrEF 40% in the Get With The Guidelines-Heart Failure registry between October 2015 and December 2018, and eligible for sacubitril/valsartan. Associations between discharge prescription of sacubitril/valsartan and clinical outcomes were assessed after inverse probability of treatment weighting and adjustment for other HFrEF medications. Overall, 1551 (10.9%) patients were discharged on sacubitril/valsartan. Of those not prescribed sacubitril/valsartan, 7857 (62.0%) were prescribed an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker. Over 12-month follow-up, compared with a discharge prescription of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, sacubitril/valsartan was independently associated with lower all-cause mortality (adjusted hazard ratio [HR], 0.82; 95% CI, 0.72-0.94; = 0.004) but not all-cause hospitalization (adjusted HR, 0.97; 95% CI, 0.89-1.07; = 0.55) or heart failure hospitalization (adjusted HR, 1.04; 95% CI, 0.91-1.18; = 0.59). Patients prescribed sacubitril/valsartan versus those without a prescription had lower risk of all-cause mortality (adjusted HR, 0.69; 95% CI, 0.60-0.79; < 0.001), all-cause hospitalization (adjusted HR, 0.90; 95% CI, 0.82-0.98; = 0.02), but not heart failure hospitalization (adjusted HR, 0.94; 95% CI, 0.82-1.08; = 0.40). Conclusions Among patients hospitalized for HFrEF, prescription of sacubitril/valsartan at discharge was independently associated with reduced postdischarge mortality compared with angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, and reduced mortality and all-cause hospitalization compared with no sacubitril/valsartan. These findings support the use of sacubitril/valsartan to improve postdischarge outcomes among older patients hospitalized for HFrEF in routine US clinical practice.