Use of Sacubitril/Valsartan in heart failure with reduced ejection fraction

摘要

Background Angiotensin receptor and neprilysin inhibition(ARNI) has been shown to reduce cardiovascular mortality. However, there is a paucity of real-world data in the effects of ARNI in heart failure patients with reduced ejection fraction(HFr EF). Methods We included 225 consecutive HFr EF patients receiving combined sacubitril/valsartan administration and standard HF treatment(Group A) and 550 consecutive HFr EF patients receiving only the standard HF treatment(Group B) from January 2016 to January 2018. Primary outcome was death from cardiovascular causes or first unplanned hospitalization for HF. Results Thirty-three deaths or first unplanned hospitalization for HF occurred in Group A(14.7%) and 102 in Group B(22.7%) with 0.56 hazard ratio(HR), and 95% confidence interval(CI, 0.491-0.867;P=0.001) during a follow-up of 12 month. Moreover, escalation of sacubitril/valsartan(89 cases, 39.6%) was associated with the best clinical outcomes(P<0.001). But,the patients with severe hypotension and baseline SBP less than 100 mm Hg in both groups had similar primary outcome. Conclusions Sacubitril/valsartan has beneficial effect on HFr EF patients and the effect enhances when higher dose is given.[S Chin J Cardiol 2019;20(4):252-257]