Physicians' Academy for Cardiovascular Education

ARNI initiation during hospitalization in real-world HFrEF patients is safe

Safety of sacubitril/valsartan initiated during hospitalization: data from a non-selected cohort

Literature - López-Azor JC, Vicent L, Valero-Masa MJ et al., - ESC Heart Fail. 2019. doi: 10.1002/ehf2.12527.

Introduction and methods

Compared to enalapril treatment, sacubitril/valsartan treatment for HF with reduced ejection fraction (HFrEF) more effectively reduces CV mortality and hospital admission when started in a stable phase in outpatients [1]. In addition, sacubitril/valsartan treatment has been shown to be safe when initiated during admission, predicting its extended use in inpatients [2, 3]. However, generalizability of these findings is limited because patients included in clinical trials often do not represent real-life patients.

The present study compares the clinical profile of a non-selected cohort of inpatients who initiated sacubitril/valsartan treatment during admission (n=100), with the clinical profile of patients included in the PIONEER-HF trial (n=440) (Comparison of Sacubitril-Valsartan versus Enalapril on Effect on N-terminal pro-B type natriuretic peptide in Patients Stabilized from an Acute Heart Failure Episode) [2]. Also, the safety and tolerance of sacubitril/valsartan treatment is compared between the inpatient cohort (n=100) and an outpatient cohort (n=427). A register with prospective follow-up was performed, enrolling patients from 17 Spanish hospitals with indication of initiated treatment based on HFrEF, Functional Class ≥ II, and systolic blood pressure ≥ 100 mmHg and with serum potassium ≤ 5.4 mmol/L. Follow-up outcome measures included functional class, left ventricular ejection fraction, treatment changes and titration, de-escalation or removal of sacubitril/valsartan, potential adverse effects attributed to sacubitril/valsartan (symptomatic hypotension, renal failure, hyperkalaemia, and angioedema), unexpected hospital admissions, and all-cause death.

Main results


Sacubitril/valsartan treatment initiation in hospitalized HFrEF patients in daily clinical practice is safe. Inpatients more frequently receive low starting doses of sacubitril/valsartan as compared to outpatients.


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Find this article online at ESC Heart Failure

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