Clinical Outcomes in Patients With Acute Decompensated Heart Failure Randomly Assigned to Sacubitril/Valsartan or Enalapril in the PIONEER-HF Trial

enalapril heart failure hospitalization valsartan I n outpatients with chronic heart failure (HF) with reduced ejection fraction known to tolerate an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, substitution of the angiotensin-neprilysin inhibitor sacubitril/valsartan reduces the rate of cardiovascular death or HF hospitalization. 1 Accordingly, consensus guidelines recommend the use of sacubitril/valsartan to treat patients with symptomatic HF with reduced ejection fraction. 2 Until recently, however, the efficacy and safety of sacubitril/valsartan among patients hospitalized for acute decompensated heart failure (ADHF) was unknown. We have reported the primary results of the randomized double-blind PIONEER-HF trial (Comparison of Sacubitril-Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilized from an Acute Heart Failure Episode) demonstrating that, in comparison with enalapril, in patients hemodynamically stabilized during hospitalization for ADHF, sacubitril/ valsartan achieved a greater reduction in N-terminal pro-brain natriuretic peptide concentration, was safe and well-tolerated, and was associated with a significant reduction in the serious composite clinical end point of death, rehospitalization for HF, implantation of a left ventricular assist device, or listing for cardiac transplantation (hazard ratio, 0.54; 95% CI, 0.37-0.79). 3 By design, 4 our previously reported analyses of clinical end points relied on investigator-reported data.