Early Administration of Sacubitril/Valsartan is Associated with more Rapid NT-proBNP Recovery in High-Risk Patients Hospitalized for Acute Heart Failure
Main Article Content
Abstract
BACKGROUND: in patients hospitalized for heart failure with reduced ejection fraction (HFrEF), randomized controlled trials have demonstrated some advantages in starting sacubitril/valsartan before discharge. However, information about the effects of sacubitril/valsartan use in the acute phase of HfrEF hospitalizations is limited.
AIM: To evaluate clinical, biomarker, and echocardiographic effects of starting sacubitril/valsartan in real-world HFrEF patients before discharge. METHODS: retrospective analysis of 124 consecutive patients (58.9% males, 75.6±11.4 years) hospitalized for HFrEF. In 36, sacubitril/valsartan was started before discharge (Group A); in the remaining 88, at the 1-month follow-up visit (Group B). The primary endpoint was time-averaged NT-proBNP level reduction from admission to discharge. RESULTS: Group A showed a worse baseline clinical risk profile (diabetes: 47.2 vs. 20.7%, p=0.007; coronary artery disease: 66.7 vs. 22.7%, p<0.001; systolic blood pressure: 118.0±20.8 vs. 132.9±22.9 mmHg, p=0.001; left ventricular ejection fraction: 28.5±5.5 vs. 32.1±7.6%, p<0.0004). Nevertheless, the time-averaged mean NT-proBNP reduction was significantly higher in group A patients (ratio of change -0.30, 95% CI -0.40 to -0.21, <0.0001 vs. group B). Creatinine and K+ levels did not change significantly during the hospital stay. Multivariate analysis suggested diabetes, coronary artery disease, higher systolic blood pressure, and the need for inotropic support as independent predictors for in-hospital sacubitril/valsartan treatment.
CONCLUSIONS: in real-world patients, starting sacubitril/valsartan in-hospital rather than waiting for further stabilization was associated with a more considerable reduction of NT-proBNP levels at discharge, with an excellent safety profile. These data confirm randomized trials results, extending them to higher-risk real-world HFrEF patients.
Keywords:
sacubitril/valsartan, ARNI, acute heart failure, heart failure therapy
Article Details
How to Cite
LUPI, Alessandro et al.
Early Administration of Sacubitril/Valsartan is Associated with more Rapid NT-proBNP Recovery in High-Risk Patients Hospitalized for Acute Heart Failure.
Medical Research Archives, [S.l.], v. 11, n. 5, may 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3714>. Date accessed: 25 apr. 2024.
doi: https://doi.org/10.18103/mra.v11i4.3714.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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21. Fudim M, Sayeed S, Xu H, Matsouaka RA, Heidenreich PA, Velazquez EJ, Yancy CW, Fonarow GC, Hernandez AF and DeVore AD. Representativeness of the PIONEER-HF Clinical Trial Population in Patients Hospitalized With Heart Failure and Reduced Ejection Fraction. Circ Heart Fail. 2020;13:e006645.
22. Rodrigues G, Tralhao A, Aguiar C, Freitas P, Ventosa A and Mendes M. Is the PARADIGM-HF cohort representative of the real-world heart failure patient population? Rev Port Cardiol (Engl Ed). 2018;37:491-496.
23. Yandrapalli S, Andries G, Biswas M and Khera S. Profile of sacubitril/valsartan in the treatment of heart failure: patient selection and perspectives. Vasc Health Risk Manag. 2017;13:369-382.
24. Simpson J, Benson L, Jhund PS, Dahlstrom U, McMurray JJV and Lund LH. "Real World" Eligibility for Sacubitril/Valsartan in Unselected Heart Failure Patients: Data from the Swedish Heart Failure Registry. Cardiovasc Drugs Ther. 2019;33:315-322.
25. Carballo D, Stirnemann J, Garin N, Marti C, Serratrice J and Carballo S. Eligibility for sacubitril-valsartan in patients with acute decompensated heart failure. ESC Heart Fail. 2020;7:1282-1290.
26. Moliner-Abos C, Rivas-Lasarte M, Pamies Besora J, Fluvia-Brugues P, Sole-Gonzalez E, Mirabet S, Lopez Lopez L, Brossa V, Pirla MJ, Mesado N, Alvarez-Garcia J and Roig E. Sacubitril/Valsartan in Real-Life Practice: Experience in Patients with Advanced Heart Failure and Systematic Review. Cardiovasc Drugs Ther. 2019;33:307-314.
27. Norberg H, Bergdahl E and Lindmark K. Eligibility of sacubitril-valsartan in a real-world heart failure population: a community-based single-centre study. ESC Heart Fail. 2018;5:337-343.
28. Cox ZL, Nandkeolyar S, Johnson AJ, Lindenfeld J and Rali AS. In-hospital Initiation and Up-titration of Guideline-directed Medical Therapies for Heart Failure with Reduced Ejection Fraction. Card Fail Rev. 2022;8:e21.
29. Tomasoni D, Fonarow GC, Adamo M, Anker SD, Butler J, Coats AJS, Filippatos G, Greene SJ, McDonagh TA, Ponikowski P, Rosano G, Seferovic P, Vaduganathan M, Voors AA and Metra M. Sodium-glucose co-transporter 2 inhibitors as an early, first-line therapy in patients with heart failure and reduced ejection fraction. Eur J Heart Fail. 2022;24:431-441.
30. Bhatt DL, Szarek M, Steg PG, Cannon CP, Leiter LA, McGuire DK, Lewis JB, Riddle MC, Voors AA, Metra M, Lund LH, Komajda M, Testani JM, Wilcox CS, Ponikowski P, Lopes RD, Verma S, Lapuerta P, Pitt B and Investigators S-WT. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure. N Engl J Med. 2021;384:117-128.
31. Voors AA, Angermann CE, Teerlink JR, Collins SP, Kosiborod M, Biegus J, Ferreira JP, Nassif ME, Psotka MA, Tromp J, Borleffs CJW, Ma C, Comin-Colet J, Fu M, Janssens SP, Kiss RG, Mentz RJ, Sakata Y, Schirmer H, Schou M, Schulze PC, Spinarova L, Volterrani M, Wranicz JK, Zeymer U, Zieroth S, Brueckmann M, Blatchford JP, Salsali A and Ponikowski P. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat Med. 2022;28:568-574.
32. Tromp J, Ponikowski P, Salsali A, Angermann CE, Biegus J, Blatchford J, Collins SP, Ferreira JP, Grauer C, Kosiborod M, Nassif ME, Psotka MA, Brueckmann M, Teerlink JR and Voors AA. Sodium-glucose co-transporter 2 inhibition in patients hospitalized for acute decompensated heart failure: rationale for and design of the EMPULSE trial. Eur J Heart Fail. 2021;23:826-834.
33. Bhatt DL, Drozda JP, Jr., Shahian DM, Chan PS, Fonarow GC, Heidenreich PA, Jacobs JP, Masoudi FA, Peterson ED and Welke KF. ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and The Society of Thoracic Surgeons. J Am Coll Cardiol. 2015;66:2230-2245.
34. Bader F, Manla Y, Atallah B and Starling RC. Heart failure and COVID-19. Heart Fail Rev. 2021;26:1-10.
2. Gheorghiade M and Pang PS. Acute heart failure syndromes. J Am Coll Cardiol. 2009;53:557-573.
3. Greene SJ, Fonarow GC, Vaduganathan M, Khan SS, Butler J and Gheorghiade M. The vulnerable phase after hospitalization for heart failure. Nat Rev Cardiol. 2015;12:220-9.
4. Abdin A, Anker SD, Butler J, Coats AJS, Kindermann I, Lainscak M, Lund LH, Metra M, Mullens W, Rosano G, Slawik J, Wintrich J and Bohm M. 'Time is prognosis' in heart failure: time-to-treatment initiation as a modifiable risk factor. ESC Heart Fail. 2021;8:4444-4453.
5. Gheorghiade M, Vaduganathan M, Fonarow GC and Bonow RO. Rehospitalization for heart failure: problems and perspectives. J Am Coll Cardiol. 2013;61:391-403.
6. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A and Group ESCSD. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599-3726.
7. Wachter R, Senni M, Belohlavek J, Straburzynska-Migaj E, Witte KK, Kobalava Z, Fonseca C, Goncalvesova E, Cavusoglu Y, Fernandez A, Chaaban S, Bohmer E, Pouleur AC, Mueller C, Tribouilloy C, Lonn E, J ALB, Gniot J, Mozheiko M, Lelonek M, Noe A, Schwende H, Bao W, Butylin D, Pascual-Figal D and Investigators T. Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail. 2019;21:998-1007.
8. Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K, Rocha R, Braunwald E and Investigators P-H. Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. N Engl J Med. 2019;380:539-548.
9. Liang HW, Liao CT, Lin WY, Chung FP, Huang JL, Lee YH, Lin PL, Chiou WR, Hsu CY and Chang HY. The evolution of guideline-directed medical therapy among decompensated HFrEF patients in sacubitril/valsartan era: Medical expenses and clinical effectiveness. J Chin Med Assoc. 2021;84:588-595.
10. Martyn T, Faulkenberg KD, Yaranov DM, Albert CL, Hutchinson C, Menon V, Estep JD, Nissen SE, Tang WHW and Starling RC. Initiation of Angiotensin Receptor-Neprilysin Inhibitor in Heart Failure With Low Cardiac Output. J Am Coll Cardiol. 2019;74:2326-2327.
11. Martyn T, Faulkenberg KD, Albert CL, Il'giovine ZJ, Randhawa VK, Donnellan E, Menon V, Estep JD, Nissen SE, Wilson Tang WH and Starling RC. Acute Hemodynamic Effects of Sacubitril-Valsartan In Heart Failure Patients Receiving Intravenous Vasodilator and Inotropic Therapy. J Card Fail. 2021;27:368-372.
12. Chng BLK, Hon JS, Chan H, Zheng Y, Gao F, Teo LYL and Sim KLD. Safety and Tolerability of Sacubitril/Valsartan Initiation in Inpatient Versus Outpatient Setting: A Retrospective Real World Study. Heart Lung Circ. 2021;30:674-682.
13. Akerman CC and Beavers JC. Risk Factors for Intolerance of Inpatient Sacubitril/Valsartan Initiation. J Pharm Pract. 2021;34:454-458.
14. Peppin KL, Tellor KB, Armbruster AL and Schwarze MW. Evaluating the safety and tolerability of inpatient sacubitril/valsartan initiation in a community hospital. J Community Hosp Intern Med Perspect. 2020;10:38-44.
15. Acanfora D, Scicchitano P, Acanfora C, Maestri R, Goglia F, Incalzi RA, Bortone AS, Ciccone MM, Uguccioni M and Casucci G. Early Initiation of Sacubitril/Valsartan in Patients with Chronic Heart Failure After Acute Decompensation: A Case Series Analysis. Clin Drug Investig. 2020;40:493-501.
16. McGinlay M, Straw S, Jagger J, Nouri B, Gierula J and Witte KK. Impact of the COVID-19 pandemic on the management of chronic heart failure. Rev Cardiovasc Med. 2021;22:271-276.
17. Velazquez EJ, Morrow DA, DeVore AD, Ambrosy AP, Duffy CI, McCague K, Hernandez AF, Rocha RA and Braunwald E. Rationale and design of the comParIson Of sacubitril/valsartaN versus Enalapril on Effect on nt-pRo-bnp in patients stabilized from an acute Heart Failure episode (PIONEER-HF) trial. Am Heart J. 2018;198:145-151.
18. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P and Group ESCSD. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-2200.
19. Senni M, Wachter R, Witte KK, Straburzynska-Migaj E, Belohlavek J, Fonseca C, Mueller C, Lonn E, Chakrabarti A, Bao W, Noe A, Schwende H, Butylin D, Pascual-Figal D and Investigators T. Initiation of sacubitril/valsartan shortly after hospitalisation for acutely decompensated heart failure in patients with newly diagnosed (de novo) heart failure: a subgroup analysis of the TRANSITION study. Eur J Heart Fail. 2020;22:303-312.
20. Pascual-Figal D, Wachter R, Senni M, Bao W, Noe A, Schwende H, Butylin D, Prescott MF and Investigators T. NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction: TRANSITION Study. JACC Heart Fail. 2020;8:822-833.
21. Fudim M, Sayeed S, Xu H, Matsouaka RA, Heidenreich PA, Velazquez EJ, Yancy CW, Fonarow GC, Hernandez AF and DeVore AD. Representativeness of the PIONEER-HF Clinical Trial Population in Patients Hospitalized With Heart Failure and Reduced Ejection Fraction. Circ Heart Fail. 2020;13:e006645.
22. Rodrigues G, Tralhao A, Aguiar C, Freitas P, Ventosa A and Mendes M. Is the PARADIGM-HF cohort representative of the real-world heart failure patient population? Rev Port Cardiol (Engl Ed). 2018;37:491-496.
23. Yandrapalli S, Andries G, Biswas M and Khera S. Profile of sacubitril/valsartan in the treatment of heart failure: patient selection and perspectives. Vasc Health Risk Manag. 2017;13:369-382.
24. Simpson J, Benson L, Jhund PS, Dahlstrom U, McMurray JJV and Lund LH. "Real World" Eligibility for Sacubitril/Valsartan in Unselected Heart Failure Patients: Data from the Swedish Heart Failure Registry. Cardiovasc Drugs Ther. 2019;33:315-322.
25. Carballo D, Stirnemann J, Garin N, Marti C, Serratrice J and Carballo S. Eligibility for sacubitril-valsartan in patients with acute decompensated heart failure. ESC Heart Fail. 2020;7:1282-1290.
26. Moliner-Abos C, Rivas-Lasarte M, Pamies Besora J, Fluvia-Brugues P, Sole-Gonzalez E, Mirabet S, Lopez Lopez L, Brossa V, Pirla MJ, Mesado N, Alvarez-Garcia J and Roig E. Sacubitril/Valsartan in Real-Life Practice: Experience in Patients with Advanced Heart Failure and Systematic Review. Cardiovasc Drugs Ther. 2019;33:307-314.
27. Norberg H, Bergdahl E and Lindmark K. Eligibility of sacubitril-valsartan in a real-world heart failure population: a community-based single-centre study. ESC Heart Fail. 2018;5:337-343.
28. Cox ZL, Nandkeolyar S, Johnson AJ, Lindenfeld J and Rali AS. In-hospital Initiation and Up-titration of Guideline-directed Medical Therapies for Heart Failure with Reduced Ejection Fraction. Card Fail Rev. 2022;8:e21.
29. Tomasoni D, Fonarow GC, Adamo M, Anker SD, Butler J, Coats AJS, Filippatos G, Greene SJ, McDonagh TA, Ponikowski P, Rosano G, Seferovic P, Vaduganathan M, Voors AA and Metra M. Sodium-glucose co-transporter 2 inhibitors as an early, first-line therapy in patients with heart failure and reduced ejection fraction. Eur J Heart Fail. 2022;24:431-441.
30. Bhatt DL, Szarek M, Steg PG, Cannon CP, Leiter LA, McGuire DK, Lewis JB, Riddle MC, Voors AA, Metra M, Lund LH, Komajda M, Testani JM, Wilcox CS, Ponikowski P, Lopes RD, Verma S, Lapuerta P, Pitt B and Investigators S-WT. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure. N Engl J Med. 2021;384:117-128.
31. Voors AA, Angermann CE, Teerlink JR, Collins SP, Kosiborod M, Biegus J, Ferreira JP, Nassif ME, Psotka MA, Tromp J, Borleffs CJW, Ma C, Comin-Colet J, Fu M, Janssens SP, Kiss RG, Mentz RJ, Sakata Y, Schirmer H, Schou M, Schulze PC, Spinarova L, Volterrani M, Wranicz JK, Zeymer U, Zieroth S, Brueckmann M, Blatchford JP, Salsali A and Ponikowski P. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat Med. 2022;28:568-574.
32. Tromp J, Ponikowski P, Salsali A, Angermann CE, Biegus J, Blatchford J, Collins SP, Ferreira JP, Grauer C, Kosiborod M, Nassif ME, Psotka MA, Brueckmann M, Teerlink JR and Voors AA. Sodium-glucose co-transporter 2 inhibition in patients hospitalized for acute decompensated heart failure: rationale for and design of the EMPULSE trial. Eur J Heart Fail. 2021;23:826-834.
33. Bhatt DL, Drozda JP, Jr., Shahian DM, Chan PS, Fonarow GC, Heidenreich PA, Jacobs JP, Masoudi FA, Peterson ED and Welke KF. ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and The Society of Thoracic Surgeons. J Am Coll Cardiol. 2015;66:2230-2245.
34. Bader F, Manla Y, Atallah B and Starling RC. Heart failure and COVID-19. Heart Fail Rev. 2021;26:1-10.