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Sacubitril, Valsartan combo effective in high risk heart failure patients: Circulation
USA: Treating high-risk patients hospitalized for acute decompensated heart failure with sacubitril/valsartan reduces the risk of CV death or re-hospitalization for heart failure, show results from the PIONEER-HF study. The findings of the study are published in the journal Circulation: Heart Failure.
Initiation of sacubitril/valsartan versus enalapril in patients stabilized during hospitalization for acute decompensated HF decreases the risk of rehospitalization for HF or cardiovascular (CV) death without increasing the risk of adverse events. Whether potentially high-risk subpopulations have a similar risk-benefit profile is not known.
Against this background, David D. Berg, Harvard Medical School, Boston, MA, and colleagues performed PIONEER-HF (Comparison of Sacubitril/Valsartan Versus Enalapril on Effect on NT-proBNP [N-terminal pro-B type natriuretic peptide] in Patients Stabilized From an Acute HF Episode). PIONEER-HF was a multicenter, randomized, double-blind trial of in-hospital initiation of sacubitril/valsartan (n=440) versus enalapril (n=441) in patients stabilized during hospitalization for acute decompensated HF.
The composite of rehospitalization for HF or cardiovascular death was adjudicated. Safety outcomes included symptomatic hypotension, worsening renal function, and hyperkalemia.
The researchers evaluated heterogeneity in the effect of sacubitril/valsartan on these safety in selected subgroups of clinical concern -- patients with baseline systolic blood pressure ≤118 mm Hg (median; n=448), baseline NT-proBNP >2701 pg/mL (median; n=395), estimated glomerular filtration rate <60 mL/minute per 1.73 m2 (n=455), ≥1 additional hospitalization for HF within the prior year (n=343), admission to the ICU during the index hospitalization (n=96), inotrope use during the index hospitalization (n=68), and severe congestion (n=219).
Key findings of the study include:
- The relative risk reduction in cardiovascular death or rehospitalization for HF with sacubitril/valsartan versus enalapril was consistent across all high-risk subgroups.
- The risks of worsening renal function, symptomatic hypotension, and hyperkalemia with sacubitril/valsartan versus enalapril were also consistent in each high- versus low-risk subgroup.
"In high-risk subpopulations admitted for acute decompensated HF, treatment with sacubitril/valsartan after initial stabilization conferred a consistent reduction in cardiovascular death or rehospitalization for HF and was well tolerated," concluded the authors.
The study titled, "Efficacy and Safety of Sacubitril/Valsartan in High-Risk Patients in the PIONEER-HF Trial," is published in the journal Circulation: Heart Failure.
DOI: https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.120.007034
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751