How safe is sacubitril-valsartan plus spironolactone for ADHF?

Initiation of sacubitril-valsartan with spironolactone during hospitalization for acute decompensated heart failure (ADHF) does not result in more adverse drug reactions (ADRs), reports a study. However, patients on this regimen tend to develop hyperkalemia.

This multicentre, retrospective, propensity-score matched cohort study was conducted across seven acute-care hospitals within a large healthcare system.

The authors analysed all adult patients admitted with ADHF between 1 January 2019 and 31 December 2021 who received sacubitril-valsartan with mineralocorticoid receptor antagonists (MRA) or without MRA and had a left ventricular ejection fraction (LVEF) <40 percent.

Two hundred twenty patients underwent screening, of whom 179 met the eligibility criteria. After propensity-score matching, 50 patients in the MRA group were matched to 50 counterparts in the non-MRA group.

The overall incidence of ADRs was numerically greater in the non-MRA group than the MRA group (24 percent vs 20 percent; p=0.629). On the other hand, the MRA group showed a significantly higher incidence of hyperkalemia (10 percent vs 0 percent; p=0.022).

In addition, patients in the MRA group were more likely to be readmitted within 30 days due to an ADR compared to those in the non-MRA group (6 percent vs 0 percent; p=0.079).

“The addition of spironolactone to sacubitril-valsartan in the hospital setting following stabilization of ADHF did not lead to a significantly greater incidence of overall ADRs, but patients were more likely to develop hyperkalemia, and there was a numerically higher incidence of 30-day readmissions due to ADRs,” the authors said.