Key result
Sacubitril/valsartan was associated with a lower incidence of all-cause mortality compared to ACEI/ARB in patients with HFrEF (7.83% vs. 10.15%; HR 1.31), with significant benefits observed in those with chronic kidney disease.
Why the study?
The differential effect of sacubitril/valsartan and ACEIs/ARBs on clinical and renal outcomes in patients with HFrEF and chronic kidney disease remained unknown.
Does sacubitril/valsartan improve clinical and renal outcomes compared to ACEI/ARB in HFrEF patients with and without CKD?
Cohort (n=3,735)
Yes
Does sacubitril/valsartan improve clinical and renal outcomes compared to ACEI/ARB in HFrEF patients with and without CKD?
Hazard Ratio: 1.31 (95% CI 1.01–1.71)
Absolute Event Rate: 7.83% vs 10.15%
p-value: p=0.04
Sacubitril/valsartan is associated with lower all-cause mortality compared to ACEI/ARB in symptomatic HFrEF patients with concurrent chronic kidney disease.
May favor sacubitril/valsartan over ACEI/ARB for mortality in CKD-HFrEF; hypothesis-generating, needs RCTs before practice change.
BACKGROUND: Impaired renal function is frequently observed in patients with heart failure and reduced ejection fraction (HFrEF). The differential effect of sacubitril/valsartan and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEIs/ARBs) on the clinical and renal outcomes in patients with HFrEF and chronic kidney disease (CKD) remains unknown. AIMS: This study aimed to explore the differential effect of sacubitril/valsartan and ACEI/ARB on the clinical and renal outcomes as well as renal function over a 12-month follow-up period in HFrEF patients with and without CKD. METHODS: Patients with HfrEF (LVEF ≤35%) and NYHA class ≥II were enrolled from the Chang Gung Research Database between 2017 and 2020. Baseline characteristics were compared between patients prescribed sacubitril/valsartan and ACEI/ARB. After propensity score matching, the following clinical and renal outcomes were compared between the two groups in patients with and without CKD over a 12-month follow-up period: acute kidney injury (AKI), emergent dialysis/renal death, HF hospitalization, cardiovascular mortality, and all-cause mortality. RESULTS: This study enrolled 3735 HFrEF patients with a mean left ventricular EF of 27.56 ± 5.86%, who had been prescribed sacubitril/valsartan (N = 1708) or ACEI/ARB (N = 2027). After propensity score matching, the clinical and renal outcomes did not differ between the sacubitril/valsartan and ACEI/ARB groups in patients without CKD. In patients with CKD, the ACEI/ARB group had a significantly higher incidence of all-cause mortality than the sacubitril/valsartan group (14.89% vs. 10.50%; hazard ratio 1.46; 95% confidence interval 1.06-2.00; p = 0.02), and the incidence of AKI, HF hospitalization, and CV mortality did not differ between the two groups. CONCLUSIONS: Sacubitril/valsartan had a lower all-cause mortality compared to ACEI/ARB in symptomatic HFrEF patients with CKD. Further prospective randomized studies are warranted to confirm our findings.
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Lee et al. (2023) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=3,735). Sacubitril/valsartan vs. ACEI/ARB was evaluated on All-cause mortality (HR 1.31, 95% CI 1.01-1.71, p=0.04). Sacubitril/valsartan was associated with a lower incidence of all-cause mortality compared to ACEI/ARB in patients with HFrEF (7.83% vs. 10.15%; HR 1.31), with significant benefits observed in those with chronic kidney disease.
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