OP2-3 - Comparing the effect of Sacubitril/Valsartan Versus renin-angiotensin system (RAS) blockade in time to first heart failure exacerbation

Background: Heart failure (HF) is an escalating clinical and public health problem affecting an estimated 64 million people globally. In 2014, a novel medication, ARNi, was shown to decrease all-cause mortality, and HF hospitalization than enalapril in ambulatory patients with Heart Failure with reduced ejection fraction (HFrEF). This study was done to compare the impact of Sacubitril/Valsartan Versus renin-angiotensin system (RAS) blockade on time to first heart failure exacerbation 

Methods:

We conducted a retrospective longitudinal cohort study using electronic medical record data from Brigham and Women’s Hospital (BWH) (July 2015–August 2021). Patients with confirmed diagnosis of HFrEF were identified in two cohorts: (1) Use ARNI and (2) Use of RAS blockade (ACE inhibitor, ACEI; or angiotensin receptor blocker, ARB) with the HF standard of care therapy. Propensity score matching, Kaplan Meier plots, Log rank tests, and Wilcoxon tests were used to assess the survival pattern. The Cox proportional hazards model for multivariable analysis was discussed.

Results:

Of more than 7000 patients with HFrEF, 1725 pairs could be matched between the 2 groups. The mean age of 64.6 +13.6 years in ARNi group while 65.6 +14.2 with RAS blockade group.

Mean ARNi days to first hospitalization was 1718 days (95% CI 1672.59 – 1763.85) while this figure was 1366 days in the RAS blockade group(95% CI 1320.42 – 1412.42). HRs comparing ARNI with RAS blockade were 0.479 (95% CI 0.415 to 0.554) adjusted for other risk factors (age, GFR< 60, Prior diabetes, Prior hospitalization, SGLT-2 inhibitorm SBP< 90 mmHg) favoring ARNI.

Conclusion:

ARNI treatment was associated with lower risk of CHF exacerbation compared with RAS blockade in adults with HFrEF.