Comparative Effectiveness of Sacubitril-Valsartan Versus ACE/ARB Therapy in Heart Failure With Reduced Ejection Fraction.
Comparative Effectiveness of Sacubitril-Valsartan Versus ACE/ARB Therapy in Heart Failure With Reduced Ejection Fraction.
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DOI：
10.1016/j.jchf.2019.08.003
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发表时间：
2020-01
期刊：
影响因子：
--
通讯作者：
Dunlay SM
中科院分区：
文献类型：
--
作者：
Tan NY;Sangaralingham LR;Sangaralingham SJ;Yao X;Shah ND;Dunlay SM
在PARADIGM-HF试验中，沙库比曲-缬沙坦与依那普利相比降低了心力衰竭（HF）患者的死亡和住院风险，并降低了射血分数。然而，沙库比曲-缬沙坦和ACE抑制剂/血管紧张素受体阻滞剂（ACE/ARB）在常规临床实践中治疗的患者中的比较有效性尚不清楚。比较沙库巴曲-缬沙坦与ACE/ARB治疗收缩期HF的疗效。我们在美国行政索赔数据库中确定了2015年7月1日至2018年2月1日期间接受沙库比曲-缬沙坦或ACE/ARB治疗的收缩期HF患者。一对一倾向评分匹配用于平衡患者的29个临床变量。使用考克斯模型比较治疗组之间的结局。共纳入7893对匹配配对;平均（SD）随访时间为6.3（5.4）个月。沙库比曲-缬沙坦与全因死亡率或全因住院风险降低相关（HR 0.86，95% CI 0.81-0.91，p<0.001），全因死亡率（HR 0.80，95% CI 0.66-0.97，p=0.027）和全因住院（HR 0.86，95% CI 0.80-0.91，p<0.001），但不是HF住院（HR 1.07，95% CI 0.96-1.19，p=0.26）。在白人（HR 0.83，95% CI 0.76-0.90）中观察到沙库比曲-缬沙坦的主要结局风险较低，但在黑人（21%的人群，HR 1.00，95% CI 0.88-1.15，相互作用p=0.032）中未观察到。未观察到按性别或年龄列出的治疗反应存在统计学显著性差异。与ACE/ARB相比，沙库比曲-缬沙坦在收缩期HF患者异质性队列中的死亡和住院风险较低。然而，我们发现沙库比曲-缬沙坦和ACE/ARB在黑人患者中的结局相似，需要进一步评价。
Sacubitril-valsartan reduced risks of death and hospitalization for heart failure (HF) versus enalapril in ambulatory patients with HF and reduced ejection fraction in the PARADIGM-HF trial. However, the comparative effectiveness of sacubitril-valsartan and ACE inhibitors / angiotensin receptor blockers (ACE/ARB) in patients treated in routine clinical practice is unclear. To compare the effectiveness of sacubitril-valsartan and ACE/ARB in systolic HF. We identified patients with systolic HF in a U.S. administrative claims database treated with sacubitril-valsartan or ACE/ARB from 07/01/15–02/01/18. One-to-one propensity score matching was used to balance patients on 29 clinical variables. Cox models were used to compare outcomes between treatment groups. A total of 7893 matched pairs were included; mean (SD) follow-up was 6.3 (5.4) months. Sacubitril-valsartan was associated with lower risks of all-cause mortality or all-cause hospitalization (HR 0.86, 95% CI 0.81–0.91, p<0.001), all-cause mortality (HR 0.80, 95% CI 0.66–0.97, p=0.027), and all-cause hospitalization (HR 0.86, 95% CI 0.80–0.91, p<0.001), but not HF hospitalization (HR 1.07, 95% CI 0.96–1.19, p=0.26). A lower risk of the primary outcome with sacubitril-valsartan was observed in whites (HR 0.83, 95% CI 0.76–0.90) but not blacks (21% of population, HR 1.00, 95% CI 0.88–1.15, interaction p=0.032). No statistically significant differences in treatment response by sex or age were observed. Sacubitril-valsartan was associated with lower risks of death and hospitalization compared with ACE/ARB in a heterogeneous cohort of patients with systolic HF. However, our finding that outcomes with sacubitril-valsartan and ACE/ARBs were similar in black patients warrants further evaluation.
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影响因子：
9.7
作者：
Sangaralingham, Lindsey R.;Sangaralingham, S. Jeson;Dunlay, Shannon M.
通讯作者：
Dunlay, Shannon M.
影响因子：
120.7
作者：
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通讯作者：
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影响因子：
9.7
作者：
Wallace, Paul J.;Shah, Nilay D.;Crown, William H.
通讯作者：
Crown, William H.
影响因子：
2
作者：
Austin, Peter C.
通讯作者：
Austin, Peter C.
DOI：
10.1161/circoutcomes.116.002653
发表时间：
2016-05
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Sangaralingham LR;Shah ND;Yao X;Roger VL;Dunlay SM
通讯作者：
Dunlay SM