Comparative Effectiveness of Sacubitril-Valsartan Versus ACE/ARB Therapy in Heart Failure With Reduced Ejection Fraction

Tan, Nicholas; Sangaralingham, Lindsey R.; Sangaralingham, S. Jeson; Yao, Xiaoxi; Shah, Nilay D.; Dunlay, Shannon M.

doi:10.1016/j.jchf.2019.08.003

Cited by 48 publications

(61 citation statements)

References 25 publications

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“…Of these 16 studies, most (n = 10) compared either with standard of care (n = 6) or before versus after sac/val use (n = 4). All six studies comparing the effects of sac/val with ACEi/ARBs were conducted in the US and reported a significantly lower risk of all-cause hospitalisation with sac/val [12,13,16,[18][19][20] (Fig. 1A).…”

Section: Clinical Effectiveness Outcomesmentioning

confidence: 99%

Real-world effectiveness and safety of sacubitril/valsartan in heart failure: A systematic review

Proudfoot

Studer

Rajput

et al. 2021

International Journal of Cardiology

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Background: PARADIGM-HF demonstrated superiority of sacubitril/valsartan (sac/val) over enalapril in patients with heart failure with reduced ejection fraction (HFrEF). However, patients in clinical practice may differ in their characteristics and overall risk compared with patients in clinical trials, and additional outcomes can be observed in real world (RW). Hence, a systematic review was conducted to identify and describe RW data on sac/val. Methods: RW studies evaluating the effects of sac/val in adult patients with HFrEF with a sample size ≥100 were identified via MEDLINE® and Embase® from 2015 to January 2020. Citations were screened, critically appraised and relevant data were extracted. Results: A total of 68 unique studies were identified. Nearly half of the studies were conducted in Europe (n = 34), followed by the US (n = 15) and Asia (n = 11). Median follow-up period varied from 1 to 19 months. Mean age ranged between 48.7 and 79.0 years; patients were mostly male and in New York Heart Association (NYHA) functional class II/III, and mean left ventricular ejection fraction varied between 23%and 38%. Of studies performing comparisons, most reported superior efficacy of sac/val in reducing the risk of HF hospitalisations, allcause hospitalisations, and all-cause mortality as compared to standard-of-care. Many studies reported significant improvements in NYHA functional class and reduction in biomarker levels post sac/val. Hypotension and hyperkalaemia were the most frequently reported adverse events. Conclusions: This comprehensive overview of currently available RW evidence on sac/val complements the evidence from randomised controlled trials, substantiating its effectiveness in heterogeneous real-world HF populations.

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Section: Clinical Effectiveness Outcomesmentioning

confidence: 99%

Real-world effectiveness and safety of sacubitril/valsartan in heart failure: A systematic review

Proudfoot

Studer

Rajput

et al. 2021

International Journal of Cardiology

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“…In addition to a reduction in the rate of mortality and hospitalisation [ 2 , 3 ], both randomised clinical trials and real-life studies have shown that sacubitril/valsartan induced the “reverse remodelling” of the left ventricle (LV), with a reduction in the ventricular volumes, an increase in the ejection fraction (EF) [ 4 , 5 ], an improvement in the diastolic function [ 6 , 7 ], and a reduction in the degree of functional mitral regurgitation [ 8 ]. In patients with HFrEF, the increased LV filling pressure induces right ventricle (RV) chronic overload, which increases RV afterload and thus leads to RV remodelling, with a reduction in the performance of RV even when it is not directly involved in the development of cardiovascular disease [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Masarone

Errigo

Melillo

et al. 2020

JCM

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Background: right ventricle-pulmonary artery (RV-PA) coupling assessed by measuring the tricuspid anular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been recently proposed as an early marker of right ventricular dysfunction in patients with heart failure with a reduced ejection fraction (HFrEF). Methods: As the effects of sacubitril/valsartan therapy on RV-PA coupling remain unknown, this study aimed to analyse the effect of this drug on TAPSE/PASP in patients with HFrEF. We retrospectively analysed all outpatients with HFrEF referred to our unit between October 2016 and July 2018. Results: At the 1-year follow-up, sacubitril/valsartan therapy was associated with a significant improvement in TAPSE (18.26 ± 3.7 vs. 19.6 ± 4.2 mm, p < 0.01), PASP (38.3 ± 15.7 vs. 33.7 ± 13.6, p < 0.05), and RV-PA coupling (0.57 ± 0.25 vs. 0.68 ± 0.30 p < 0.01). These improvements persisted at the 2-year follow-up. In the multivariable analysis, the improvement in the RV-PA coupling was independent of the left ventricular remodelling. Conclusions: in patients with HFrEF, sacubitril/valsartan improved the RV-PA coupling; however, further trials are necessary to evaluate the role of sacubitril/valsartan in the treatment of right ventricle (RV) dysfunction either associated or not associated with left ventricular dysfunction.

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“…Although the dose of S/V used was still among the standard dosing 15 . Subsequent “real world” studies also show a significant increase in hypotensive episodes with S/V as compared with ACEI 16 . Thus, despite estimates of profound benefit to HF patients, in current clinical practice, many patients cannot tolerate high doses of S/V, or even the smallest approved dose of 24/26 mg twice daily due to several factors including hypotension 10,17,18 .…”

Section: Introductionmentioning

confidence: 99%

Novel doses of sacubitril/valsartan in patients unable to tolerate traditional therapy: Effects on N‐terminal pro B‐type natriuretic peptide levels

Pandey

Jer

Kuo

et al. 2020

Clinical Cardiology

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BackgroundWidespread use of angiotensin receptor blocker and neprilysin inhibitor (ARNI) remains low, and many patients are unable to tolerate the medication due to hypotension at the currently recommended starting dose.HypothesisThe aim of this study is to assess if lower than standard doses of ARNI, sacubitril/valsartan (S/V), significantly reduces NT‐proBNP and leads to any change in diuretic dose, serum potassium, or creatinine.MethodsIn a retrospective study of 278 patients who were started on a low dose S/V at a single medical center, 45 patients were selected for the study cohort. Patients were subcategorized to Group 1 (n = 10): very low dose S/V (half a tab of 24/26 mg BID), Group 2 (n = 10): very low dose titrated to low dose S/V, and Group 3 (n = 25): low dose S/V (24/26 mg BID). NT‐proBNP, diuretic dose, serum potassium, and creatinine were compared before and after initiation of S/V.ResultsAmong all groups, there was a significant reduction in NT‐proBNP level (Group 1: p < .01, Group 2: p < .01, and Group 3: p < .001). In addition, there was a significant reduction in diuretic dose across all groups combined (furosemide 53 mg/day vs. 73 mg/day; p = .03), with 17.8% (8/45) patients being able to discontinue their diuretic completely. There was no significant change in potassium or creatinine.ConclusionsLower than standard dose of S/V significantly reduces NT‐proBNP and diuretic requirement without change in potassium or creatinine, which provides hope that patients who cannot tolerate standard doses of S/V due to hypotension may be able to receive the benefits of S/V therapy.

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Comparative Effectiveness of Sacubitril-Valsartan Versus ACE/ARB Therapy in Heart Failure With Reduced Ejection Fraction

Cited by 48 publications

References 25 publications

Real-world effectiveness and safety of sacubitril/valsartan in heart failure: A systematic review

Real-world effectiveness and safety of sacubitril/valsartan in heart failure: A systematic review

Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Novel doses of sacubitril/valsartan in patients unable to tolerate traditional therapy: Effects on N‐terminal pro B‐type natriuretic peptide levels

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