In-hospital initiation of sacubitril/valsartan was not significantly associated with a difference in 30-day hospital readmission compared to delayed outpatient initiation (aOR 0.91).
Cohort (n=4,156)
No
Does in-hospital initiation of sacubitril/valsartan reduce 30-day hospital readmission in adult patients hospitalized with HFrEF compared to delayed outpatient initiation?
In-hospital initiation of sacubitril/valsartan in HFrEF patients was not associated with a significant reduction in 30-day hospital readmission compared to delayed outpatient initiation.
Effect estimate: aOR 0.91 (95% CI 0.50-1.67)
Absolute Event Rate: 21% vs 23%
p-value: p=0.764
Background: Heart failure with reduced ejection fraction (HFrEF) remains associated with high rates of hospitalization and early readmission, with approximately 20-25% of patients readmitted within 30 days. Sacubitril/valsartan is a key component of guideline-directed medical therapy, but the optimal timing of initiation during hospitalization versus after discharge remains uncertain. Objective: This study aimed to evaluate whether initiation of sacubitril/valsartan during hospitalization is associated with improved short-term outcomes compared with delayed outpatient initiation. Methods: This retrospective cohort study used the MIMIC-IV database. Adult patients hospitalized with HFrEF who received sacubitril/valsartan were included. Patients were classified into in-hospital initiation and delayed outpatient initiation groups based on medication timing. The primary outcome was 30-day hospital readmission, and the secondary outcome was in-hospital mortality. Multivariable logistic regression was used to assess associations after adjustment for age, sex, race, and the Charlson Comorbidity Index. Results: A total of 4,156 hospitalizations were included. There was no significant association between timing of sacubitril/valsartan initiation and 30-day readmission (aOR=0.91; 95% CI: 0.50-1.67; p=0.764). Higher comorbidity burden was associated with increased readmission risk (aOR=1.04; 95% CI: 1.00-1.07; p=0.035). No significant difference in in-hospital mortality was observed between groups. Conclusion: Timing of sacubitril/valsartan initiation was not associated with short-term outcomes. Comprehensive management strategies beyond the timing of therapy may be important for improving outcomes in this population.
Oletu et al. (Tue,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=4,156). In-hospital initiation of sacubitril/valsartan vs. Delayed outpatient initiation of sacubitril/valsartan was evaluated on 30-day hospital readmission (aOR 0.91, 95% CI 0.50-1.67, p=0.764). In-hospital initiation of sacubitril/valsartan was not significantly associated with a difference in 30-day hospital readmission compared to delayed outpatient initiation (aOR 0.91).