Sex-based Differences in Biomarkers, Quality of Life, and Reverse Cardiac Remodeling in Patients with Heart Failure with Reduced Ejection Fraction Treated with Sacubitril/valsartan

Background Among patients with heart failure with reduced ejection fraction (HFrEF, left ventricular [LV] EF ≤ 40%), female sex is associated with differences compared to men. Objectives To determine sex-based differences in biomarkers, self-reported health status, and magnitude of longitudinal changes in measures of reverse cardiac remodeling among HFrEF patients treated with sacubitril/valsartan (S/V). Methods This was a planned subgroup analysis of patients initiated on S/V in the Prospective Study of Biomarkers, Symptom Improvement and Ventricular Remodeling During Entresto Therapy for Heart Failure (PROVE-HF) Study. Results There were 226 (28.5%) women in the study. Though women had lower baseline N-terminal pro B-type natriuretic peptide (NT-proBNP), they had more rapid early reduction in the biomarker after initiation of S/V. Compared to men, women had lower average baseline Kansas City Cardiomyopathy Questionnaire (KCCQ)-23 Total Symptom Score (67.6 vs 71.9; P =.003) but showed greater linear improvement (7.4 vs. 5.5 points; P Conclusions In women with HFrEF, treatment with S/V was well-tolerated, and associated with unique differences in NT-proBNP change, reverse cardiac remodeling and change in KCCQ-23 score compared to men (PROVE-HF; NCT02887183).