Sacubitril/valsartan was associated with lower rates of cardiovascular death (0.9% vs 6.6%) and heart failure rehospitalization (30.4% vs 46.5%) compared to ACEIs/ARBs in patients with HFrEF and CKD.
Cohort (n=129)
Does sacubitril/valsartan improve clinical outcomes and cardiac function compared to ACEIs/ARBs in Chinese patients with HFrEF and moderate-to-severe CKD?
In Chinese patients with HFrEF and moderate-to-severe CKD, sacubitril/valsartan (mostly at lower target doses) was associated with significantly lower rates of cardiovascular death and heart failure rehospitalization compared to ACEIs/ARBs.
Absolute Event Rate: 0.9% vs 6.6%
Background and Objectives: The efficacy and safety of a lower target dose of sacubitril/valsartan (angiotensin receptor neprilysin inhibitor ARNI) for treating heart failure with reduced ejection fraction (HFrEF) in Chinese patients with moderate-to-severe chronic kidney disease (CKD) remain unknown. We performed a retrospective study to compare the efficacy of ARNI with that of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) in patients with HFrEF and moderate-to-severe CKD. Methods: This retrospective study included 129 patients. An inverse probability of treatment weighting (IPTW) analysis was performed to compare the baseline characteristics and outcomes between the 2 groups. The incidence of death due to cardiovascular disease, rehospitalization due to heart failure after treatment, and improvement in cardiac function symptoms (New York Heart Association NYHA) were assessed after 12 months. Improvements of ejection fraction (EF), N-terminal pro-brain natriuretic peptide (NT-proBNP) level, left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD) were compared. Results: Compared with the ACEI/ARB group, the ARNI group, with 90.77% (59/65) in the lower target dose group, showed a lower rate of death due to cardiovascular disease (6.6% vs 0.9% after IPTW) and a lower incidence of rehospitalization (46.5% vs 30.4% after IPTW). NYHA class, estimated glomerular filtration rate, EF, NT-ProBNP levels, LVEDD, and LVESD improved in the ARNI group. None of the patients withdrew from treatment because of adverse drug reactions. Conclusion: Our study showed that ARNI resulted in a greater improvement in heart failure than ACEIs/ARBs in patients with HFrEF and moderate-to-severe CKD.
Zhang et al. (Mon,) conducted a cohort in Heart failure with reduced ejection fraction and moderate-to-severe chronic kidney disease (n=129). Sacubitril/Valsartan (ARNI) vs. Angiotensin-converting enzyme inhibitors (ACEIs) / Angiotensin receptor blockers (ARBs) was evaluated on Death due to cardiovascular disease. Sacubitril/valsartan was associated with lower rates of cardiovascular death (0.9% vs 6.6%) and heart failure rehospitalization (30.4% vs 46.5%) compared to ACEIs/ARBs in patients with HFrEF and CKD.
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