OBJECTIVES

Heart Failure (HF) is a leading cause of hospitalization in the U.S. Sacubitril/valsartan (SAC/VAL) reduced risk of death and HF hospitalization compared to enalapril in patients with HF enrolled in the PARADIGM-HF trial. However, little is known about the real-world effectiveness of SAC/VAL nor the comparative effectiveness of SAC/VAL with aldosterone antagonists on preventing hospitalization. This study aimed to compare effectiveness of SAC/VAL versus an aldosterone antagonist for preventing HF-related and all-cause hospitalization in patients with systolic HF.

METHODS

We conducted a retrospective cohort study of patients with systolic HF using the IBM MarketScan commercial claims database from 1^st January 2014 to 31^st December 2018. Patients were included if they were aged ≥18 years, had first systolic HF (identified based on ICD-9/ICD-10 codes) hospital admission on or after 1^st January 2015, and initiated SAC/VAL or an aldosterone antagonist after HF discharge. Patients were also required to have ≥1-year continuous eligibility prior to the index admission (baseline period). Patients were excluded if they initiated SAC/VAL or aldosterone antagonist therapy during the baseline period. Initiation date of SAC/VAL or aldosterone antagonist was index prescription date. Follow-up continued until first hospitalization after index prescription date. After 1:3 propensity score (PS) matching, we employed Cox proportional hazards regression with robust variance estimator to compare all-cause and HF-related hospitalization between groups.

RESULTS

We matched 1,697 SAC/VAL new-users with 4,714 aldosterone antagonist new-users. SAC/VAL users had a 21% lower risk of all-cause hospitalization (adjusted hazard ratio [aHR]: 0.79, 95% confidence interval [CI]: 0.71 - 0.88) and a 20% lower risk of HF-related hospitalization (aHR: 0.80, 95% CI: 0.67 - 0.96) compared to aldosterone antagonist users.

CONCLUSIONS

SAC/VAL was associated with lower risks of all-cause and HF-related hospitalization compared to aldosterone antagonists.