Association Between Sacubitril/valsartan Initiation And Real-world Health Status Trajectories Over 1 Year In Heart Failure With Reduced Ejection Fraction

Introduction Improving the health status—symptoms, function, and quality of life - of patients with HFrEF is a primary goal of treatment. Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), improves short-term health status in clinical practice, but whether these improvements are sustained has not been assessed. Methods Using data from CHAMP-HF, a multicenter observational study of outpatients with HFrEF (EF ≤40%), patients initiated on ARNI were matched 1:2 to patients not started on ARNI using propensity score Cox models that included sociodemographic and clinical variables, medical history, medications, and baseline Kansas City Cardiomyopathy Questionnaire (KCCQ) Symptom Frequency and Quality of Life scores. Five repeated measures models, one for the overall KCCQ score and one for each domain, were used to compare the health status trajectories of patients initiated on ARNI vs not. Results Among 3,930 patients, 746 (19.0%) were initiated on ARNI and 576 were matched to 1,152 patients not started on ARNI. Prior to matching, patients initiated on ARNI were more likely to be younger, non-Hispanic, have lower EF and a history of ventricular arrhythmia, and were less likely to be taking an ACEI or ARB, but were more likely to be on beta-blockers and mineralocorticoid receptor antagonists. Patients initiated on ARNI experienced improved quality of life by 3 months that persisted to 12 months, with the largest benefit observed in the KCCQ Quality of Life domain (Figure 1). Conclusion In a real-world setting, the health status benefits of ARNI therapy occur within 3 months and persists up to 12-months after initiating therapy.