Sacubitril/valsartan’s real-world benefits in HFrEF patients with ESRD

In a real-world population of Ko­rean patients with heart failure with reduced ejection fraction (HFrEF) and end-stage renal disease (ESRD) on haemodialysis, sacubitril/valsartan has demonstrated significant benefits vs renin-angiotensin system (RAS) blockade in reducing all-cause mor­tality and any hospitalization.

Using 2017–2021 data from the Korean National Health Insurance Service database, researchers iden­tified 2,248 eligible patients who re­ceived sacubitril/valsartan and 2,528 eligible patients who received RAS blockade for comparison of a com­posite primary outcome of all-cause mortality or any hospitalization by in­verse probability treatment weights. [Ahn Y, et al, AHA 2024]

Results showed a significantly lower risk of all-cause mortality or any hospitalization at 2 years with sacubitril/valsartan vs RAS blockade (hazard ratio [HR], 0.74; 95 percent confidence interval [CI], 0.75–0.96; p=0.009).

Significant risk reductions were also observed with sacubitril/valsar­tan in all-cause mortality (HR, 0.74; 95 percent CI, 0.59–0.93; p=0.008) and any hospitalization (HR, 0.85; 95 percent CI, 0.75–0.95; p=0.007).

“The benefits of sacubitril/val­sartan vs RAS blockade were more definite in the subpopulation of pa­tients with a proportion of days cov­ered ≥80 percent,” the researchers pointed out. In these patients, HRs for all-cause mortality, cardiovascular (CV) mortality, and any hospitaliza­tion were 0.61 (95 percent CI, 0.46– 0.80; p<0.001), 0.59 (95 percent CI, 0.43–0.82; p=0.001), and 0.80 (95 percent CI, 0.80–0.94; p=0.007), respectively.

“The results suggest the impor­tance of medication adherence in im­proving CV outcomes,” the research­ers commented.