Compared to enalapril treatment, sacubitril/valsartan treatment for HF with reduced ejection fraction (HFrEF) more effectively reduces CV mortality and hospital admission when started in a stable phase in outpatients [1]. In addition, sacubitril/valsartan treatment has been shown to be safe when initiated during admission, predicting its extended use in inpatients [2, 3]. However, generalizability of these findings is limited because patients included in clinical trials often do not represent real-life patients.
The present study compares the clinical profile of a non-selected cohort of inpatients who initiated sacubitril/valsartan treatment during admission (n=100), with the clinical profile of patients included in the PIONEER-HF trial (n=440) (Comparison of Sacubitril-Valsartan versus Enalapril on Effect on N-terminal pro-B type natriuretic peptide in Patients Stabilized from an Acute Heart Failure Episode) [2]. Also, the safety and tolerance of sacubitril/valsartan treatment is compared between the inpatient cohort (n=100) and an outpatient cohort (n=427). A register with prospective follow-up was performed, enrolling patients from 17 Spanish hospitals with indication of initiated treatment based on HFrEF, Functional Class ≥ II, and systolic blood pressure ≥ 100 mmHg and with serum potassium ≤ 5.4 mmol/L. Follow-up outcome measures included functional class, left ventricular ejection fraction, treatment changes and titration, de-escalation or removal of sacubitril/valsartan, potential adverse effects attributed to sacubitril/valsartan (symptomatic hypotension, renal failure, hyperkalaemia, and angioedema), unexpected hospital admissions, and all-cause death.
Sacubitril/valsartan treatment initiation in hospitalized HFrEF patients in daily clinical practice is safe. Inpatients more frequently receive low starting doses of sacubitril/valsartan as compared to outpatients.
1. Mc Murray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014; 371: 993–1004.
2. Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K, Rocha R, Braunwald E. Angiotensinneprilysin inhibition in acute decompensated heart failure. N Engl J Med 2019; 380: 539–548.
3. Wachter R, Senni M, Belohlavek J, Butylin D, Noe A, Pascual-Figal D. TRANSITION study Investigators. Initiation of sacubitril/valsartan in hospitalized patients with heart failure with reduced ejection fraction after hemodynamic stabilization: primary results of the TRANSITION study. Eur Heart J 2018; 39: 1.
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