The following is a summary of “Effects of Sacubitril/Valsartan vs Valsartan in De Novo vs Acute on Chronic HFpEF and HFmrEF,” published in the June 2024 issue of Cardiology by Murray et al.

Decompensated heart failure (HF) can arise as a new-onset or worsening of existing chronic HF. In PARAGLIDE-HF (Prospective comparison of ARNI and ARB Given following stabiLization In DEcompensated HFpEF), among stabilized patients with ejection fraction >40%, sacubitril/valsartan showed greater N-terminal pro-B-type natriuretic peptide (NT-proBNP) reduction and clinical benefit compared to valsartan.

Researchers conducted a prospective study assessing how HF chronicity influenced the effects of sacubitril/valsartan. 

They classified patients as either de novo (first HF diagnosis) or chronic (known HF). NT-proBNP changes from baseline to weeks 4 and 8 were analyzed using an analysis of the covariance model. A win ratio was also assessed for each group, consisting of time to cardiovascular death, number of HF hospitalizations during follow-up, number of urgent HF visits during follow-up, and NT-proBNP changes. 

The results showed that out of 466 participants, 33% (n=153) had de novo HF, and 67% (n=313) had chronic HF. De novo patients had fewer atrial fibrillation cases and lower creatinine levels. The reduction in NT-proBNP with sacubitril/valsartan vs. valsartan was not significant for both De novo (0.82; 95% CI: 0.62-1.07) and chronic HF (0.88; 95% CI: 0.73-1.07), interaction P= 0.66. The win ratio slightly favored sacubitril/valsartan for both groups (de novo [1.12, 95% CI: 0.70-1.58] and chronic HF [1.24; 95% CI: 0.89-1.71]). 

Investigators concluded that the effect of sacubitril/valsartan was not influenced by whether patients had new-onset or chronic heart failure. 

Source: jacc.org/doi/10.1016/j.jacadv.2024.100984