Sacubitril plus valsartan reduces early readmission risk in HF
medwireNews: The risk of readmission within 30 days of heart failure (HF) hospitalisation is reduced by a quarter for patients receiving sacubitril/valsartan (LCZ696) compared with those receiving enalapril, an analysis of PARADIGM-HF trial data shows.
“Reducing early readmissions after HF hospitalization represents an opportunity to simultaneously improve patient outcomes and reduce the fiscal burden of HF management for hospitals and payers”, say Scott Soloman (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and co-authors.
“These data […] provide additional rationale for use of sacubitril/valsartan in preference to enalapril in patients with chronic, symptomatic HF and reduced ejection fraction”, they write in the Journal of the American College of Cardiology.
During a median follow-up period of 27 months, there were 2383 investigator-reported HF hospitalisations (including multiple hospitalisations per patient) in the 8399 PARADIGM HF participants. Of these, 1076 (45.2%) occurred in individuals assigned to LCZ696 and 1307 (54.8%) occurred in individuals assigned to enalapril.
Fewer patients in the LCZ696 than the enalapril group were readmitted to hospital for any cause within 30 days, at 17.8% versus 21.0%, reflecting a significant 26.0% lower likelihood. The same was true for HF readmission, with rates of 9.7% versus 13.4% and a significant 38% lower likelihood.
These differences persisted at 60 days following hospital discharge and in sensitivity analyses restricted to adjudicated HF hospitalisations, patients enrolled in the USA and a subset of Medicare-eligible patients over 65 years of age.
Of note, it appeared that the magnitude of LCZ696 benefit over enalapril was greater for HF-specific readmission in patients over 65 years, who had a 53% risk reduction, compared with a 17% reduction in younger patients.
By contrast, the younger patients in the LCZ696 group experienced greater reductions in the risk of all-cause readmission, at 35%, than the older patients, at 18%.
In an accompanying editorial, Robert Mentz and Emily O’Brien, from the Duke Clinical Research Institute in Durham, North Carolina, USA, say that this “interesting” observation “may offer insights into the underlying mechanisms by which sacubitril/valsartan benefits patients with different phenotypes.”
They add that the analysis by Soloman et al is “clinically relevant” and “provides important data supporting the use of sacubitril/valsartan to reduce readmissions in patients with HF with reduced ejection fraction.”
Mentz and O’Brien caution, however, that “it is unknown whether similar results would be seen in those with less clinical stability and/or more advanced HF characterized by hypotension and renal dysfunction”, adding that “these data do not apply to approximately 50% of the HF population with preserved ejection fraction.”
By Laura Cowen
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