Bhatt Ankeet S, Vaduganathan Muthiah, Jena Barada P, Suminska Sylwia, Eid Carlos, Schwende Heike, Senni Michele
Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, California, USA.
Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
ESC Heart Fail. 2025 Jun;12(3):1682-1692. doi: 10.1002/ehf2.15183. Epub 2025 Jan 30.
Large-scale, real-world data on early initiation of sacubitril/valsartan in patients newly diagnosed (de novo) with HF with reduced ejection fraction (HFrEF) are limited. We examined the effectiveness of sacubitril/valsartan versus angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) on all-cause and cause-specific hospitalizations among patients with de novo HFrEF from the Optum® dataset in the United States.
This retrospective cohort study included adult patients with de novo HFrEF (diagnosed ≤30 days) with left ventricular ejection fraction (LVEF) ≤40% who were first prescribed with sacubitril/valsartan or ACEi/ARB from 1 January 2016 to 31 March 2020. The primary endpoint (all-cause hospitalization) and secondary endpoints were analysed in propensity score-matched cohorts.
A cohort of 3290 patients with de novo HFrEF who were prescribed with sacubitril/valsartan and a propensity-matched cohort of 6580 patients who were prescribed with ACEi/ARB were analysed. Overall, the mean (SD) age of patients was 63 (14) years, 34% were women, and baseline characteristics were balanced across treatment groups. Hypertension (67%), diabetes (33%) and chronic kidney disease (28%) were highly prevalent comorbidities. Patients in the sacubitril/valsartan cohort when compared with the ACEi/ARB cohort had lower annual rates of all-cause hospitalizations [incidence rate ratio (IRR): 0.81, 95% confidence interval (CI): 0.75-0.89, P < 0.001], cardiovascular (CV) hospitalizations (IRR: 0.80, 95% CI: 0.73-0.87, P < 0.001) and HF hospitalizations (IRR: 0.86, 95% CI: 0.78-0.95, P = 0.002).
Among patients with de novo HFrEF, sacubitril/valsartan (compared with that of ACEi/ARB) was associated with fewer all-cause, CV and HF hospitalizations. These findings are consistent with clinical trial evidence suggesting potential benefits of early initiation of sacubitril/valsartan in patients with HFrEF, including those soon after diagnosis.
关于新诊断的射血分数降低的心力衰竭（HFrEF）患者早期起始使用沙库巴曲缬沙坦的大规模真实世界数据有限。我们在美国Optum®数据集中研究了沙库巴曲缬沙坦与血管紧张素转换酶抑制剂（ACEi）/血管紧张素受体阻滞剂（ARB）相比，对新诊断的HFrEF患者全因住院和特定病因住院的有效性。
这项回顾性队列研究纳入了2016年1月1日至2020年3月31日首次处方沙库巴曲缬沙坦或ACEi/ARB的新诊断HFrEF（诊断≤30天）且左心室射血分数（LVEF）≤40%的成年患者。在倾向评分匹配队列中分析主要终点（全因住院）和次要终点。
分析了一组3290例新诊断HFrEF且处方了沙库巴曲缬沙坦的患者以及一组倾向评分匹配的6580例处方了ACEi/ARB的患者。总体而言，患者的平均（标准差）年龄为63（14）岁，34%为女性，各治疗组的基线特征均衡。高血压（67%）、糖尿病（33%）和慢性肾脏病（28%）是高度常见的合并症。与ACEi/ARB队列相比，沙库巴曲缬沙坦队列患者的全因住院年发生率更低[发生率比（IRR）：0.81，95%置信区间（CI）：0.75 - 0.89，P < 0.001]，心血管（CV）住院发生率更低（IRR：0.80，95%CI：0.73 - 0.87，P < 0.001），心力衰竭住院发生率更低（IRR：0.86，95%CI：0.78 - 0.95，P = 0.002）。
在新诊断的HFrEF患者中，沙库巴曲缬沙坦（与ACEi/ARB相比）与全因、CV和HF住院次数减少相关。这些发现与临床试验证据一致，表明早期起始使用沙库巴曲缬沙坦对HFrEF患者有潜在益处，包括诊断后不久的患者。
