Long term outcomes with sacubitril valsartan in HFrEF: insights from a real world cohort
S Martinez Gutierrez, F A Romano Matos, M Galvan Ruiz, M Fernandez De Sanmamed Giron, M Singh, E Fuente Gonzalez, M V Groba Marco, M Lopez Perez, E Caballero Dorta, L Burgos Ramirez, J Gutierrez Rodriguez, A Cardenes Leon, J J Garcia Salvador, C Acosta Calero, A Garcia QuintanaAbstract
Introduction
Heart failure (HF) is a common chronic condition associated with high morbidity and mortality. Sacubitril–valsartan (SV) has shown to provide significant prognostic benefits in patients with heart failure with reduced ejection fraction (HFrEF). However, its long-term impact in real-life clinical practice remains unclear.
Objective
To assess the impact of long-term SV use in a real-world cohort of HFrEF patient.
Methods
An observational, single-center registry was conducted including patients with HFrEF who started SV between 2017 and 2019. Baseline characteristics, NYHA functional class and echocardiographic parameters were collected. Patients were stratified in two groups as if they had or not a HF event. It was defined as HF admission, visit to emergency department or death for any cause during follow-up. A posterior subanalysis was performed using Kaplan Meyer curves and long-rank test to asses which comorbidities relates with HF events.
Results
A total of 379 patients were included; 25% were female, with a mean age of 69.1 ± 12.1 years and a median follow-up of 2,425 days.
61.5% experienced a HF event (n=233). Patients with a HF event were older, had more comorbidities, worse baseline functional class and higher prevalent of prior HF admissions before starting SV. The main HF etiology in our registry was ischemic which was more prevalent in the HF event group.
According to analytical data, patients in HF event group showed higher baseline NT-proBNP levels and worse renal function. Baseline echocardiographic data was similar, except for higher pulmonary artery pressures in HF event group.
Baseline guideline directed medical therapy (GDMT) was similar in both groups, except for greater use of diuretics (p<0.001). During follow-up, patients without an HF event achieved higher rates of SGLT2i and MRA use and better SV titration. (Figure 1).
Long-term HF prognosis was worse in patients with ischemic etiology, diabetes mellitus, impaired renal function, atrial fibrilation and lack of GDMT. (Figure 2).
Conclusions
In this real-world HFrEF cohort, long-term follow-up revealed a high rate of HF events. Patients with poor outcomes were elder, with ischemic etiology and more comorbidities such as renal failure. Otherwise, the patients with better prognosis had more rate or optimized GDMT (SV and SGLT2i).Baseline characteristicsFor image description, please refer to the figure legend and surrounding text.Kaplan–Meier curvesFor image description, please refer to the figure legend and surrounding text.