Early Administration of Sacubitril/Valsartan is Associated with more Rapid NT-proBNP Recovery in High-Risk Patients Hospitalized for Acute Heart Failure

BACKGROUND: in patients hospitalized for heart failure with reduced ejection fraction (HFrEF), randomized controlled trials have demonstrated some advantages in starting sacubitril/valsartan before discharge. However, information about the effects of sacubitril/valsartan use in the acute phase of HfrEF hospitalizations is limited. AIM: To evaluate clinical, biomarker, and echocardiographic effects of starting sacubitril/valsartan in real-world HFrEF patients before discharge. METHODS: retrospective analysis of 124 consecutive patients (58.9% males, 75.6±11.4 years) hospitalized for HFrEF. In 36, sacubitril/valsartan was started before discharge (Group A); in the remaining 88, at the 1-month follow-up visit (Group B). The primary endpoint was time-averaged NT-proBNP level reduction from admission to discharge. RESULTS: Group A showed a worse baseline clinical risk profile (diabetes: 47.2 vs. 20.7%, p=0.007; coronary artery disease: 66.7 vs. 22.7%, p<0.001; systolic blood pressure: 118.0±20.8 vs. 132.9±22.9 mmHg, p=0.001; left ventricular ejection fraction: 28.5±5.5 vs. 32.1±7.6%, p<0.0004). Nevertheless, the time-averaged mean NT-proBNP reduction was significantly higher in group A patients (ratio of change -0.30, 95% CI -0.40 to -0.21, <0.0001 vs. group B). Creatinine and K+ levels did not change significantly during the hospital stay. Multivariate analysis suggested diabetes, coronary artery disease, higher systolic blood pressure, and the need for inotropic support as independent predictors for in-hospital sacubitril/valsartan treatment. CONCLUSIONS: in real-world patients, starting sacubitril/valsartan in-hospital rather than waiting for further stabilization was associated with a more considerable reduction of NT-proBNP levels at discharge, with an excellent safety profile. These data confirm randomized trials results, extending them to higher-risk real-world HFrEF patients.