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November 11, 2018New England Journal of MedicineOpen Access

Angiotensin–Neprilysin Inhibition in Acute Decompensated Heart Failure

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Why the study?

Does sacubitril-valsartan reduce NT-proBNP concentration in patients with HFrEF hospitalized for acute decompensated heart failure compared to enalapril?

Population

881 patients with heart failure with reduced ejection fraction who were hospitalized for acute decompensated…

Comparison

Sacubitril-valsartan vs Enalapril (target dose, 10 mg twice daily)

Design

RCT, randomly assigned

Follow-up

8 weeks

Key result

Sacubitril-valsartan led to a greater reduction in NT-proBNP concentration than enalapril (ratio of change 0.71; 95% CI 0.63-0.81; P<0.001) in patients with acute decompensated heart failure.

Authors

EVEric J. VelazquezDMDavid A. MorrowADAdam D. DeVore

Discussion

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Member takes

Overview

Supports in-hospital initiation of sacubitril-valsartan in acute decompensated HF; extends prior chronic HF evidence to hospitalized patients.

Study Design

Type

RCT (n=881)

Multicenter

Yes

Structured PICO

Does sacubitril-valsartan reduce NT-proBNP concentration in patients with HFrEF hospitalized for acute decompensated heart failure compared to enalapril?

P
Population
881 patients with heart failure with reduced ejection fraction hospitalized for acute decompensated heart failure, followed for 8 weeks.
I
Intervention
Sacubitril-valsartan (target dose, 97 mg of sacubitril with 103 mg of valsartan twice daily)
C
Comparator
Enalapril (target dose, 10 mg twice daily)
O
Outcome
Time-averaged proportional change in the N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration from baseline through weeks 4 and 8surrogate

Main Result

Effect estimate: ratio of change 0.71 (95% CI 0.63 to 0.81)

Absolute Event Rate: -46.7% vs -25.3%

p-value: p=<0.001

In patients hospitalized for acute decompensated HFrEF, initiation of sacubitril-valsartan led to a significantly greater reduction in NT-proBNP compared to enalapril, with a similar safety profile.

Cite This Study

Velazquez et al. (2018) conducted an RCT in Acute decompensated heart failure (n=881). Sacubitril-valsartan vs. Enalapril (target dose, 10 mg twice daily) was evaluated on Time-averaged proportional change in the N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration from baseline through weeks 4 and 8 (ratio of change 0.71, 95% CI 0.63 to 0.81, p=<0.001). Sacubitril-valsartan led to a greater reduction in NT-proBNP concentration than enalapril (ratio of change 0.71; 95% CI 0.63-0.81; P<0.001) in patients with acute decompensated heart failure.

synapsesocial.com/papers/6a7ca6cedd4ac9e48f190a8bhttps://doi.org/10.1056/nejmoa1812851
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