Is Sacubitril/Valsartan Able to Change the Timing for Implantation of Cardiac Devices in Heart Failure with Reduced Ejection Fraction?

Abstract

Aims: The aim of this study was to evaluate the impact of sacubitril/valsartan on left ventricular (LV) reverse remodeling, potentially modifying the timing for cardiac device implantation in heart failure with reduced ejection fraction (HFrEF), which has not been specifically addressed. Methods and results: A secondary data analysis of a prospective cohort of HFrEF patients was conducted. Inclusion criteria: patients who started sacubitril/valsartan between November 2017 and August 2019 after previous optimal medical therapy. Primary endpoint: time to achieve LV Ejection Fraction (EF) > 35%. Kaplan–Meier was used to estimate median time and Cox regression model to investigate the patients’ characteristics associated with event incidence rate. In total, 48 patients were included, with a mean age of 72.5 years, predominantly male (70.8%). From the initial 48 patients with LVEF ≤ 35%, 27 (56%) reached LVEF > 35%, in a median time of 11.3 months (95% confidence interval [95%CI]: 9.4–19.6). In multivariate analysis, baseline LVEF between 30 and 35% was associated with increased cumulative incidence of attaining LVEF > 35% (Incidence rate ratio = 3.9; 95%CI: 1.6–9.9; p-value = 0.004). Conclusion: We observed an improvement in LVEF to >35% in the majority of patients who switched to sacubitril/valsartan, illustrating its role in cardiac remodeling. We speculate that this improvement may allow delaying implantation of Cardioverter-Defibrillator/Cardiac Resynchronization Therapy.

Keywords

• heart failure
• left ventricular ejection fraction
• sacubitril/valsartan
• angiotensin receptor neprilysin inhibitor
• cardiac devices
• real-world evidence