Heart failure & cardiomyopathiesCohort study
Long-term outcomes following sacubitril/valsartan therapy for chronic HFrEF: an Italian real-world multicentre study
- Multicentre retrospective study
Authors' conclusion
S/V initiation was associated with sustained improvements in NT-proBNP, quality of life, and cardiac remodelling. S/V discontinuation or dose reduction identified patients at higher MACE risk.
Study context
- Population
- HFrEF outpatients starting S/VHFrEF outpatients starting S/V
- Participants
- 592 outpatients
- Exposure
- association of dose changes with major adverse cardiovascular events
Main finding
As reported in the abstract
baseline
1000 (494-2333) pg/ml
12 months
751 (304-1726) pg/ml
last follow-up
735 (215-1980) pg/ml
P
P < .001
Observational data: associations, not effects.
Further findings
Major adverse cardiovascular events (MACE), multivariable Cox analysis
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| S/V discontinuation · independently associated with MACE · multivariable Cox analysis | 1.52 (1.28–1.97) | P = 0.040 | |
| change in GLS · independently associated with MACE · multivariable Cox analysis | 0.81 (0.67–0.98) | P = 0.028 | |
| change in KCCQ · independently associated with MACE · multivariable Cox analysis | 0.95 (0.92–0.98) | P = 0.001 | |
| 0.512Hazard ratio (log scale) |
Kansas City Cardiomyopathy Questionnaire (KCCQ) · baseline, 12 months, and last follow-up
- baseline
- 53 ± 15
- 12 months
- 62 ± 14
- last follow-up
- 66 ± 15
- P
- P < 0.001
LVEF · baseline, 12 months, and last follow-up
- baseline
- 32 ± 7
- 12 months
- 36 ± 8
- last follow-up
- 37 ± 9%
- P
- P < 0.001
GLS · baseline, 12 months, and last follow-up
- baseline
- −10.8 ± 3.2
- 12 months
- −12.3 ± 3.1
- last follow-up
- −14.0 ± 2.9%
- P
- P < 0.001
MACE · median follow-up of 3.72 years
- patients who experienced MACE
- 225 patients (38%)
- deaths
- 36
- HF hospitalizations
- 134
MACE incidence by S/V discontinuation and dose reduction
- higher with S/V discontinuation, log-rank
- P = 0.013
- higher with dose reduction, log-rank
- P = 0.014
Original publication
Summarised from the published abstract; every number is checked against it