Association between sacubitril/valsartan initiation and real‐world health status trajectories over 18 months in heart failure with reduced ejection fraction

Aims Improving the health status (symptoms, function, and quality of life) of patients with heart failure with reduced ejection fraction (HFrEF) is a primary treatment goal. Angiotensin receptor neprilysin inhibitors (ARNI) improve short‐term health status in clinical practice, but the sustainabilit...

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Bibliographic Details
Published in:ESC Heart Failure 2021-08, Vol.8 (4), p.2670-2678
Main Authors: Thomas, Merrill, Khariton, Yevgeniy, Fonarow, Gregg C., Arnold, Suzanne V., Hill, Larry, Nassif, Michael E., Chan, Paul S., Butler, Javed, Thomas, Laine, DeVore, Adam D., Hernandez, Adrian F., Albert, Nancy M., Patterson, J. Herbert, Williams, Fredonia B., Spertus, John A.
Format: Article
Language:English
Subjects:
Angiotensin‐neprilysin inhibitor
Cardiovascular disease
Clinical trials
Contraindications
Ejection fraction
Health status
Heart failure
Heart failure reduced ejection fraction
Mortality
Original
Original s
Patients
Quality of life
Sociodemographics
Variables
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Summary:Aims Improving the health status (symptoms, function, and quality of life) of patients with heart failure with reduced ejection fraction (HFrEF) is a primary treatment goal. Angiotensin receptor neprilysin inhibitors (ARNI) improve short‐term health status in clinical practice, but the sustainability of these improvements is unknown. Methods and results In CHAMP‐HF, a multicentre observational study of outpatients with HFrEF, patients initiated on ARNI were propensity score matched 1:2 to patients not using ARNI with Cox regression modelling time to ARNI initiation, adjusted for sociodemographic and clinical variables, medical history, medications, and baseline Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. Repeated measures models for the overall KCCQ score and each domain compared the health status trajectories of patients initiated on ARNI vs. not. Among 3930 participants, 746 (19.0%) began ARNI, of whom 576 were matched to 1152 non‐ARNI patients. Prior to matching, participants initiated on ARNI were younger, non‐Hispanic, had lower EFs, more commonly had a history of ventricular arrhythmia, were less likely to be taking an ACEI/ARB, and more likely to be treated with beta‐blockers and mineralocorticoid receptor antagonists. There were no differences after matching. In the matched cohort, participants initiated on ARNI experienced improved health status by 3 months that persisted through 12 months [KCCQ Overall Summary Score (OSS) = 73.4 vs. 70.8; P 
ISSN:2055-5822
2055-5822
DOI:10.1002/ehf2.13298