Association between Sacubitril/Valsartan Initiation and Health Status Outcomes inHeart Failure with Reduced Ejection Fraction:Findings from the CHAMP-HF Registry

摘要

BackgroundOptimizing patients’ health status is a primary goal for patients with heart failure and reduced ejection fraction (HFrEF). The association of sacubitril/valsartan (ARNI) with patients’ health status in clinical practice has not been described. MethodsThe Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS) was serially assessed in 3436 HFrEF patients from 140 US centers in the CHAMP-HF registry. At the time of ARNI initiation, patients were matched with 2 controls based on a time-dependent propensity score including clinical factors (6 sociodemographic, 25 clinical characteristics) and prior KCCQ-OS. Matching was further stratified by prior use of ACE/ARB therapy. Linear regression compared changes in KCCQ-OS, between patients who were versus were not initiated on an ARNI, with differences of +5, +10, and +20 points (moderate, large, and very large improvement, respectively). The proportion of matched ARNI and no-ARNI patients experiencing a large (≥ +10) or very large (≥ +20) health status improvement was determined. ResultsARNI was initiated in 365 patients matched with 730 no-ARNI patients (standardized differences <10% for all 31 characteristics; indicating good group comparability). Changes in KCCQ-OS, over a median (IQR) of 32 (26, 53) days, are shown in Figure. Mean improvement in KCCQ-OS was greater in ARNI patients (6.0±19 vs. 3.6±17, p=0.014), primarily driven by improvements in KCCQ-Symptom (5.1±21 vs. 1.6±21, p=0.007) and KCCQ-Quality of Life scores (7.5±24 vs. 4.1±24, p=0.021). The proportion of ARNI versus no-ARNI patients with a ≥ large improvement in KCCQ-OS were 34.3% vs. 28.3% and 21.4% vs. 12.5% had a very large improvement, suggesting NNTs of 16 and 11. ConclusionIn routine care, ARNI initiation was associated with rapid improvement in health status, with 1 in 11 patients experiencing a very large health status benefit compared with those not treated with an ARNI. These findings further support the use of ARNI to improve patients’ health status.