PulseExploreJournal ClubResearchersJournals
Instagram
HomeJournal ClubExplore
Synapse
⌘+K
Synapse
February 1, 2021Circulation Heart FailureOpen Access

Efficacy and Safety of Sacubitril/Valsartan in High-Risk Patients in the PIONEER-HF Trial

View Full Paper
Ask AI
Bookmark
Share

Why the study?

It was unknown whether potentially high-risk subpopulations stabilized during hospitalization for acute decompensated HF share the same risk-benefit profile from initiating sacubitril/valsartan compared with enalapril.

Does in-hospital initiation of sacubitril/valsartan reduce the composite of cardiovascular death or rehospitalization for HF in patients stabilized during hospitalization for acute decompensated heart failure compared to enalapril?

Population

Patients stabilized during hospitalization for acute decompensated HF (n=440 sacubitril/valsartan, n=441 enalapril)

Comparison

In-hospital initiation of sacubitril/valsartan vs enalapril

Design

Multicenter, randomized, double-blind trial subgroup analysis

Key result

In high-risk subpopulations with acute decompensated heart failure, sacubitril/valsartan consistently reduced cardiovascular death or HF rehospitalization compared with enalapril (P interaction=NS).

Authors

DBDavid D. BergMSMarc D. SamskyEVEric J. Velazquez

Discussion

Loading...

Member takes

Overview

Supports sacubitril/valsartan initiation across high-risk stabilized ADHF subgroups; leaves open definitive benefit pending dedicated trials.

Key Points

  • To determine whether the clinical efficacy and safety of in-hospital sacubitril/valsartan initiation compared to enalapril are consistent across high-risk subpopulations hospitalized for acute decompensated heart failure.
  • Multicenter, randomized, double-blind trial comparing in-hospital initiation of sacubitril/valsartan (n=440) with enalapril (n=441) in patients stabilized following acute decompensated heart failure.
  • Evaluated treatment effects on adjudicated cardiovascular death or heart failure rehospitalization, along with safety outcomes (worsening renal function, symptomatic hypotension, and hyperkalemia) across seven predefined high-risk clinical subgroups.
  • Sacubitril/valsartan consistently reduced the relative risk of cardiovascular death or heart failure rehospitalization compared with enalapril across all high-risk subgroups (P for interaction = non-significant for each).
  • Rates of worsening renal function, symptomatic hypotension, and hyperkalemia were comparable between sacubitril/valsartan and enalapril across high- versus low-risk subgroups (P for interaction = non-significant for each).

Study Design

Type

RCT (n=881)

Blinding

Double-blind

Randomization

randomized

Multicenter

Yes

Structured PICO

Does in-hospital initiation of sacubitril/valsartan reduce the composite of cardiovascular death or rehospitalization for HF in patients stabilized during hospitalization for acute decompensated heart failure compared to enalapril?

P
Population
881 patients stabilized during hospitalization for acute decompensated heart failure.
I
Intervention
In-hospital initiation of sacubitril/valsartan
C
Comparator
Enalapril
O
Outcome
Composite of cardiovascular death or rehospitalization for HFcomposite

In-hospital initiation of sacubitril/valsartan provides consistent cardiovascular benefits and safety across high-risk subgroups of patients stabilized after acute decompensated heart failure.

Cite This Study

Berg et al. (2021) conducted an RCT in Acute decompensated heart failure (n=881). Sacubitril/valsartan vs. Enalapril was evaluated on Cardiovascular death or rehospitalization for heart failure. In high-risk subpopulations with acute decompensated heart failure, sacubitril/valsartan consistently reduced cardiovascular death or HF rehospitalization compared with enalapril (P interaction=NS).

synapsesocial.com/papers/6a7936453b1c66cefb5af060https://doi.org/10.1161/circheartfailure.120.007034
View Full Paper
Ask AI
Bookmark
Share

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Clinical Outcomes in Patients With Acute Decompensated Heart Failure Randomly Assigned to Sacubitril/Valsartan or Enalapril in the PIONEER-HF Trial2019 · 171 citations
  2. 2Rationale and design of the comParIson Of sacubitril/valsartaN versus Enalapril on Effect on nt-pRo-bnp in patients stabilized from an acute Heart Failure episode (PIONEER-HF) trial2018 · 76 citations
  3. 3Sacubitril/Valsartan in Patients Hospitalized With Decompensated Heart Failure2024 · 30 citations
  4. 4Angiotensin–Neprilysin Inhibition in Acute Decompensated Heart Failure2018 · 1,261 citations
  5. 5Initiation of Angiotensin-Neprilysin Inhibition After Acute Decompensated Heart Failure2019 · 87 citations