Long-term outcomes following sacubitril/valsartan therapy for chronic HFrEF: an Italian real-world multicentre study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND AIMS: Long-term real-world effects of sacubitril/valsartan (S/V) and the impact of S/V dose reduction or discontinuation are less defined. We assessed longitudinal changes after S/V initiation and the association of dose changes with major adverse cardiovascular events (MACE). METHODS: Multicentre retrospective study of 592 HFrEF outpatients starting S/V (83% men; age 68 ± 10 years; LVEF 32 ± 7%). NT-proBNP, Kansas City Cardiomyopathy Questionnaire (KCCQ) and echocardiography were collected at baseline, 12 months, and last follow-up. MACE was analysed with Kaplan-Meier and Cox models. RESULTS: NT-proBNP decreased from 1000 (494-2333) to 751 (304-1726) and 735 (215-1980) pg/ml (P < .001). KCCQ improved from 53 ± 15 to 62 ± 14 and 66 ± 15 (P < .001). LVEF increased from 32 ± 7 to 36 ± 8 and 37 ± 9% (P < .001) and GLS improved from -10.8 ± 3.2 to -12.3 ± 3.1 and -14.0 ± 2.9% (P < .001). During a median follow-up of 3.72 years, 225 patients (38%) experienced MACE (36 deaths; 134 HF hospitalizations). MACE incidence was higher in patients with S/V discontinuation and with dose reduction (log-rank P = .013 and P = .014). In multivariable Cox analysis, S/V discontinuation [hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.28-1.97; P = .040], change in GLS (HR 0.81, 95% CI 0.67-0.98; P = .028) and change in KCCQ (HR 0.95, 95% CI 0.92-0.98; P = .001) were independently associated with MACE. CONCLUSIONS: S/V initiation was associated with sustained improvements in NT-proBNP, quality of life, and cardiac remodelling. S/V discontinuation or dose reduction identified patients at higher MACE risk.
Source: ESC Heart Failure
Authors: Giuseppe Dattilo, Roberto Licordari, Egidio Imbalzano, Antonio Cannata, Piergiuseppe Agostoni, Alberto Aimo, Francesco Barillà, Erberto Carluccio, Michele Ciccarelli, Gianluca Di Bella, Frank L Dini, Michele Emdin, Francesco Loria, Massimo Mapelli, Enrica Mariano, Francesco Paolo Niglio, Alberto Palazzuoli, Gianpaolo Palmieri, Simona Pavoncelli, Elisabetta Salvioni, Gianluigi Savarese, Michele Correale
Institutions: University of Messina, King's College London, British Heart Foundation, King's College Hospital NHS Foundation Trust, King's College Hospital, University of Milan, Centro Cardiologico Monzino, Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Policlinico Tor Vergata, University of Perugia, University of Salerno, IRCCS Istituto Auxologico Italiano, University of Foggia, University of Siena, Ospedale Santa Maria alle Scotte, Karolinska University Hospital, Karolinska Institutet, Ospedali Riuniti di Foggia
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,850
OpenAlex ID: W7137978635