HFrEF outcomes due to Chagas disease no better with sacubitril/valsartan vs enalapril

In the treatment of patients with heart failure with reduced ejection fraction (HFrEF) secondary to Chagas disease, the use of sacubitril/valsartan does not appear to lead to improvements in clinical outcomes compared with enalapril, according to a study.

The study included 922 Chagas disease patients (mean age 64.2 years, 42 percent female) with HFrEF (left ventricular ejection fraction of not more than 40 percent) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) of ≥600 pg/mL (or B-type natriuretic peptide [BNP] ≥150 pg/mL) or ≥400 pg/mL (or BNP ≥100 pg/mL) if hospitalized for HF within the previous 12 months.

Patients were randomly assigned to receive sacubitril/valsartan at a target dose of 200 mg (n=462) or enalapril at a target dose of 10 mg (n=460), administered twice daily in addition to standard therapy. The primary endpoint was a hierarchical composite outcome of death from cardiovascular causes, hospitalization for HF, or relative change in NT-proBNP from baseline to 12 weeks.

Over a median follow-up of 25.2 months, cardiovascular death occurred in 23.8 percent patients in the sacubitril/valsartan group and 25.4 percent of those in the enalapril group (18.3 percent vs 17.5 percent wins in the hierarchical comparison). For a first hospitalization for HF, the incidence was 22.1 percent and 24.1 percent in the sacubitril/valsartan and enalapril groups, respectively (7.7 percent vs 6.9 percent wins).

At 12 weeks, NT-proBNP decreased by a median of 30.6 percent with sacubitril valsartan and by a median of 5.5 percent with enalapril (22.5 percent vs 5.5 percent wins; p<0.001).