Influence of Sacubitril/Valsartan (LCZ696) on 30-Day Readmission After Heart Failure Hospitalization

Abstract

JACC JOURNAL CMEThis article has been selected as the month's JACC Journal CME activity, available online at http://www.acc.org/jacc-journals-cme by selecting the CME tab on the top navigation bar. Accreditation and Designation StatementThe American College of Cardiology Foundation (ACCF) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The ACCF designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. Method of Participation and Receipt of CME CertificateTo obtain credit for JACC CME, you must:1. Be an ACC member or JACC subscriber.2. Carefully read the CME-designated article available online and in this issue of the journal.3. Answer the post-test questions. At least 2 out of the 3 questions provided must be answered correctly to obtain CME credit.4. Complete a brief evaluation.5. Claim your CME credit and receive your certificate electronically by following the instructions given at the conclusion of the activity. CME Objective for This Article: After reading this article, the reader should be able to: 1) define the burden of readmissions after heart failure hospitalization in a contemporary population with heart failure and reduced ejection fraction; 2) explain the rationale for targeting early readmissions after heart failure hospitalization as a quality metric; and 3) compare the impact of different pharmacologic therapies for heart failure on rates of readmission after heart failure hospitalization. CME Editor Disclosure: JACC CME Editor Ragavendra R. Baliga, MD, FACC, has reported that he has no financial relationships or interests to disclose.Author Disclosures: The PARADIGM-HF Study was funded by Novartis AG.

Rationale and design of TRANSITION: a randomized trial of pre‐discharge vs. post‐discharge initiation of sacubitril/valsartan

“…The trial was stopped prematurely because the primary outcome, a composite of death from cardiovascular causes or hospitalization for HF, showed highly significant superiority for sacubitril/valsartan compared with enalapril: 21.8% vs. 26.5% ( P  < 0.001). The benefit was seen to a similar extent for both cardiovascular death (13.3% vs. 16.5%, P  < 0.001) and HF hospitalization (12.8% vs. 15.6%, P  < 0.001), and, remarkably, the difference between treatment groups was significant as early as Day 30 after randomization 39. Both the rate of sudden death (6.0% vs. 7.4%, P  = 0.008) and death due to worsening HF (3.5% vs. 4.4%, P  = 0.034) were reduced with sacubitril/valsartan vs. enalapril 40.…”

Potential Expanded Indications for Neprilysin Inhibitors

“…47 Further, the benefit of sacubitril/valsartan over enalparil was not attenuated or accentuated by proximity of trial enrollment to most recent prior hospitalization for HF. 48 Unfortunately, whether these inferences can be extended to patients with currently or recently decompensated HF is not knowable from the PARADIGM trial, which excluded patients with a current episode of decompensation and patients not taking at least 4 weeks of stable medical therapy with at least 10 mg/day of enalapril or equivalent.…”

Expanded algorithm for managing patients with acute decompensated heart failure

“…The PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial demonstrated better outcomes in HFrEF with treatment with ARNI compared to ACEI [55, 56]. Post hoc analysis of the PARADIGM-HF suggests that these benefits extend to improving clinical outcomes following hospitalization for HF and initiation should be considered during outpatient clinic visits [57]. The ongoing PIONEER-HF (comparison of sacubitril/valsartan versus enalapril on effect on NT-proBNP in patients stabilized from an acute heart failure episode) trial is a large, randomized, double-blind prospective study that aims to assess the effect on congestion by monitoring NT-proBNP levels in the post-discharge setting ().…”