Sacubitril/valsartan reduces all-cause hospitalizations in HF

In patients with chronic heart failure (HF) with below-normal left ventricular ejection fraction (LVEF), treatment with sacubitril/valsartan significantly reduc­es the risk of all-cause hospitalization vs renin-angiotensin system inhibitor (RASi), a post hoc pooled analysis of two pivotal trials has shown.

The analysis involved 13,194 pa­tients with chronic HF (mean age, 67 years; male, 67.3 percent) with a mean LVEF of 40 percent. Over a me­dian follow-up of 2.5 years, the rela­tive risk of all-cause hospitalization was significantly reduced by 8 per­cent with sacubitril/valsartan vs RASi (hazard ratio [HR], 0.92; 95 percent confidence interval [CI], 0.88–0.97; p=0.002). The incidence of first all-cause hospitalization was 25 vs 27 per 100 patient-years, corresponding to an absolute risk reduction of 2.1 per 100 patient-years and a number need­ed to treat (NNT) of 48 patient-years. [Liu H, ESC 2024; JAMA Cardiol 2024;9:1047-1052]

The reduction in overall hospitaliza­tions appeared to be primarily driven by lower rates of cardiac (HR, 0.88; 95 percent CI, 0.82–0.95; p=0.001) and pulmonary (HR, 0.75; 95 percent CI, 0.57–0.97; p=0.03) hospitalizations with sacubitril/valsartan. Similar rates of composite noncardiac hospital­izations were observed between the sacubitril/valsartan and RASi arms.

“Treatment heterogeneity on all-cause hospitalizations by LVEF was observed [p_interaction=0.03], with benefits most apparent in patients with LVEF <60 percent [HR, 0.91; 95 percent CI, 0.86–0.96], but not in those with LVEF ≥60 percent [HR, 0.97; 95 percent CI, 0.86–1.09],” the researchers reported.

Sacubitril/valsartan also reduced the risk of the composite of all-cause hospitalization or all-cause mortality (HR, 0.92; 95 percent CI, 0.87–0.96; p<0.001), with an absolute risk reduc­tion of 2.5 per 100 patient-years and an NNT of 40 patient-years.