Real-world utilisation of angiotensin-neprilysin inhibitors in older adults with heart failure.

Published on Jun 4, 2021in Heart5.213
· DOI :10.1136/HEARTJNL-2021-319545
Jan M. Griffin4
Estimated H-index: 4
(Columbia University),
Richard Cheng19
Estimated H-index: 19
(University of Washington Medical Center)
Sources
Abstract
Over the last decade, treatment for heart failure with reduced ejection fraction (HFrEF) has advanced, with the incremental addition of novel evidence-based medical therapies. The landmark PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) study showed that the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan was superior to enalapril in reducing risk of death and HF hospitalisations.1 This has paved the way for rapid incorporation of ARNI into the treatment guidelines for HFrEF, with additional indications on the horizon. We are now in an era of quadruple therapy that incorporates an optimal combination of beta-blockers, ACE inhibitors (ACEi)/angiotensin receptor blockers (ARB)/ARNI, mineralocorticoid receptor antagonists (MRA) and sodium/glucose cotransporter-2 inhibitors (SGLT2i) for chronic HFrEF.2 In this issue of Heart , Dr Desai and colleagues evaluate the real-world utilisation of ARNI in HFrEF patients age ≥65 years using the Medicare database (2014–2017).3 Case ascertainment of HF was based on International Classification of Diseases (ICD) codes, with further stratification dependent on a validated claims-based algorithm and/or ARNI initiation to limit the reference group to those with HFrEF. While there may be some degree of misclassification, the recently expanded US Food and Drug Administration indication for ARNI based on post hoc analysis of PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF with preserved EF) would suggest that those with HFpEF at the lower end of the ‘normal’ EF spectrum may derive similar benefit to those with HFrEF. Hence, ARNI is now indicated in patients with chronic HF regardless of EF.4 In the current manuscript, separate subcohorts were created from the HFrEF population with an ‘initiator’ group (newly starting ARNI or ACEi/ARB who were previously naive to these medications) and a ‘switcher’ group (switching from …
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Importance Sacubitril-valsartan use reduces mortality and hospitalizations compared with enalapril among patients with chronic heart failure with reduced ejection fraction (HFrEF); however, the cost-effectiveness of these treatments when initiated during hospitalization for HF is unknown. Objective To estimate the cost-effectiveness of inpatient initiation of sacubitril-valsartan vs enalapril compared with no initiation or posthospitalization initiation of sacubitril-valsartan among stabilized p...
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Summary Background Three drug classes (mineralocorticoid receptor antagonists [MRAs], angiotensin receptor–neprilysin inhibitors [ARNIs], and sodium/glucose cotransporter 2 [SGLT2] inhibitors) reduce mortality in patients with heart failure with reduced ejection fraction (HFrEF) beyond conventional therapy consisting of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and β blockers. Each class was previously studied with different background therapies and t...
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Abstract Objectives This paper aims to compare the effectiveness of sacubitril-valsartan and angiotensin-converting enzyme inhibitor (ACE)/angiotensin receptor blocker (ARB) in systolic heart failure (HF). Background Sacubitril-valsartan reduced risks of death and hospitalization for HF versus enalapril in ambulatory patients with HF and reduced ejection fraction in the PARADIGM-HF (Prospective Comparison of Angiotensin II Receptor Blocker Neprilysin Inhibitor with Angiotensin Converting Enzyme ...
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#1Poghni Peri-Okonny (MU: University of Missouri)H-Index: 2
#1Poghni A. Peri-Okonny (MU: University of Missouri)H-Index: 4
Last. John A. Spertus (MU: University of Missouri)H-Index: 141
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Abstract Objectives This study sought to determine the rate of use of target doses of foundational guideline-directed medical therapy (GDMT) in a contemporary cohort of patients with heart failure with reduced ejection fraction (HFrEF) across systolic blood pressure (SBP) categories. Background Patients with HFrEF are infrequently titrated to recommended doses of GDMT. The relationship between SBP and achieving GDMT target doses is not well studied. Methods Patients enrolled in the CHAMP-HF (Cha...
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#1Eric J. Velazquez (Yale University)H-Index: 79
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Abstract Background Acute decompensated heart failure accounts for more than 1 million hospitalizations in the United States annually. Whether the initiation of sacubitril–valsartan therapy is safe and effective among patients who are hospitalized for acute decompensated heart failure is unknown. Methods We enrolled patients with heart failure with reduced ejection fraction who were hospitalized for acute decompensated heart failure at 129 sites in the United States. After hemodynamic stabilizat...
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Importance The angiotensin receptor neprilysin inhibitor sacubitril/valsartan was associated with a reduction in cardiovascular mortality, all-cause mortality, and hospitalizations compared with enalapril. Sacubitril/valsartan has been approved for use in heart failure (HF) with reduced ejection fraction in the United States and cost has been suggested as 1 factor that will influence the use of this agent. Objective To estimate the cost-effectiveness of sacubitril/valsartan vs enalapril in the U...
66 CitationsSource
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Background We compared the angiotensin receptor–neprilysin inhibitor LCZ696 with enalapril in patients who had heart failure with a reduced ejection fraction. In previous studies, enalapril improved survival in such patients. Methods In this double-blind trial, we randomly assigned 8442 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either LCZ696 (at a dose of 200 mg twice daily) or enalapril (at a dose of 10 mg twice daily), in addition to re...
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