Heart failure & cardiomyopathiesRandomised controlled trial
Angiotensin-Neprilysin Inhibition in Patients With Mildly Reduced or Preserved Ejection Fraction and Worsening Heart Failure
- Randomised controlled trial
- double-blind
Authors' conclusion
Among patients with EF >40% stabilized after WHF, sacubitril/valsartan led to greater reduction in plasma NT-proBNP levels and was associated with clinical benefit compared with valsartan alone, despite more symptomatic hypotension.
Study context
- Population
- Patients with ejection fraction (EF) >40% enrolled within 30 days of a worsening heart failure (HF) event
- Participants
- 466 patients
- Comparison
- Sacubitril/valsartan vs valsartan
- Sacubitril/valsartann = 233
- Valsartann = 233reference
- Primary endpoint
- Time-averaged proportional change in NT-proBNP
- Follow-up
- From baseline through Weeks 4 and 8
Primary result
Time-averaged change in NT-proBNP · Weeks 4 and 8
Ratio of change
0.85
95% CI 0.73–0.999
P = 0.049
As reported in the abstract
Further findings
| Outcome | unmatched win ratio (95% CI) | P value | |
|---|---|---|---|
| Hierarchical outcome (CV death, HF hospitalizations, urgent HF visits, change in NT-proBNP) · favored sacubitril/valsartan but not significant | 1.19 (0.93–1.52) | P = 0.16 | |
| 0.512Unmatched win ratio (log scale) |
NT-proBNP change, EF ≤60% (subgroup)
- Larger treatment effect in EF ≤60% subgroup
- ratio of change 0.78 (95% CI 0.61-0.98)
Hierarchical outcome, EF ≤60% (subgroup)
- Larger treatment effect in EF ≤60% subgroup
- win ratio 1.46 (95% CI 1.09-1.95)
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Worsening renal function | 0.61 (0.40–0.93) | |
| Symptomatic hypotension | 1.73 (1.09–2.76) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Angiotensin-Neprilysin Inhibition in Patients With Mildly Reduced or Preserved Ejection Fraction and Worsening Heart Failure. J Am Coll Cardiol. Published 21 May 2023. doi:10.1016/j.jacc.2023.04.019
Summarised from the published abstract; every number is checked against it