In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
Abstract:
Introduction: Sacubitril/valsartan improves outcomes in patients with heart failure with reduced ejection fraction (HFrEF) compared to ACE inhibitors; however, comparative effectiveness data on post-discharge outcomes in renin-angiotensin system inhibitor (RASi)-naïve patients are limited. Methods: We analyzed Medicare beneficiaries age ≥65 years who were hospitalized for HFrEF in the Get With The Guidelines Heart Failure registry between 10/2015 and 6/2019, had Part D prescription coverage, and were not on RASi therapy 6 months prior to hospital admission. We examined associations between sacubitril/valsartan prescription at hospital discharge and outcomes at 30 days and 1 year after discharge using overlap weighted Cox proportional hazards models. The primary endpoint was “home-time”, defined as days alive and out of any healthcare institution. Secondary endpoints included mortality and rehospitalization. Results: Among 3,572 patients with HFrEF and naïve to RASi therapy, 290 (8.1%) were prescribed sacubitril/valsartan at hospital discharge. After adjusting for baseline patient characteristics, patients prescribed sacubitril/valsartan had greater home-time (parameter estimate [PEs] 27.0, 95%CI 12.4-41.6, p 〈 0.001) and lower all-cause mortality (HR 0.74, 95%CI 0.6-0.9, p=0.004) compared with patients not on sacubitril/valsartan. Prescription of sacubitril/valsartan was not significantly associated with all-cause (HR 0.87, 95%CI 0.7-1.0, p=0.10) or HF rehospitalization (HR 0.87, 95%CI 0.7-1.1, p=0.19) (Figure) Conclusions: In this contemporary, real-world population of RASi-naïve patients with HFrEF, initiation of sacubitril/valsartan at discharge was associated with greater home-time and improvements in overall survival similar to that seen in randomized trials. These findings support recent expert consensus recommendations endorsing a direct-to-sacubitril/valsartan therapeutic approach among RASi-naïve patients.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_1.10738
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1466401-X
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