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Heart failure and reduced ejection fraction: Sacubitril associated with Valsartan over angiotensin-converting enzyme inhibitors


The quality of evidence regarding patient-centered outcomes in adults with heart failure after Sacubitril combined with Valsartan ( Entresto ) has not been systematically appraised.

An analysis has been performed with 4 databases in February 2017, and graded the quality of evidence according to the GRADE ( Grading of Recommendations Assessment, Development and Evaluation working group ) approach.

Researchers reviewed 1 meta-analysis and multiple publications of 2 randomized controlled trials ( RCT ) and 1 unpublished RCT.

In adults with heart failure and reduced ejection fraction, low-quality evidence from 1 RCT of 8,432 patients suggests that Sacubitril combined with Valsartan reduces all-cause ( number needed to treat [ NNT ] to prevent 1 event [ NNTp ] = 35 ) and cardiovascular mortality ( NNTp = 32 ), hospitalization ( NNTp = 11 ), emergency visits ( NNTp = 69 ), and serious adverse effects, leading to treatment discontinuation ( NNTp = 63 ) and improves quality of life when compared with Enalapril.

In adults with heart failure and preserved ejection fraction, very low-quality evidence from 1 RCT of 301 patients suggests that there are no differences in mortality, morbidity, or adverse effects between Sacubitril combined with Valsartan and Valsartan alone.

In conclusion, in adults with heart failure and reduced ejection fraction, to reduce cardiovascular mortality and hospitalizations and improve quality of life, clinicians may recommend Sacubitril combined with Valsartan over angiotensin-converting enzyme inhibitors. ( Xagena )

Aronow WS, Shamliyan TA, Am J Cardiol 2017;120:1166-1170

XagenaMedicine_2017



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