– The University of Hong Kong, The University of Hong Kong, Kennedy Town, Hong Kong
Background: Management of heart failure, especially heart failure with reduced ejection fraction, has been a challenge and contributed to a relatively higher rate of readmission, mortality and morbidity. The efficacy of sacubitril/valsartan vs enalapril in Chinese patients for the prevention of hospitalization and mortality has not been fully investigated.
Objectives: To investigate the risk of hospitalization and mortality with the use of sacubitril/valsartan vs enalapril in patients with heart failure in Hong Kong.
Methods: We conducted a population-based cohort study using the electronic medical records managed by the Hong Kong Hospital Authority. Patients diagnosed with heart failure and newly prescribed with sacubitril/valsartan or enalapril from July 1, 2016 until June 30, 2019 were identified and followed up until November 1, 2021. The primary outcome was the composite of cardiovascular mortality or heart failure-related hospitalization. The secondary outcome included all-cause hospitalization, heart failure-related hospitalization, cardiovascular mortality and all-cause mortality. Inverse probability treatment weighting was employed to balance the two treatment groups and hazard ratio (HR) and confidence interval (CI) were derived using Cox regression.
Results: We identified 1,056 and 2,181 new users of sacubitril/valsartan and enalapril with a diagnosis of heart failure, respectively. Compared with enalapril, sacubitril/valsartan was associated with a lower risk of the primary composite outcome (HR 0.58, 95% CI 0.47 to 0.72), all-cause hospitalization (HR 0.81, 95% CI 0.68 to 0.96), heart failure-related hospitalization (HR 0.57, 95% CI 0.46 to 0.71), all-cause mortality (HR 0.61, 95% CI 0.48 to 0.78) but not cardiovascular mortality (HR 0.95, 95% CI 0.62 to 1.46).
Conclusions: Sacubitril/valsartan was associated with a lower risk of readmission of hospitalization and all-cause mortality in Hong Kong patients.
