More patients on target dose for ARNI in de novo HFrEF

Initiation of sacubitril/valsartan in patients with de novo heart failure with reduced ejection fraction: an analysis of the TRANSITION study

News - May 25, 2019

Presented at ESC Heart Failure 2019 in Athens, Greece, by Michele Senni Bergamo, Italy

Introduction and methods

The TRANSITION trial demonstrated that in HF patients stabilized after an acute decompensated HF event initiation of sacubitril/valsartan during hospital admission or after discharge did not result in a different number of patients on target dose for sacubitril/valsartan (97/103 mg) after 10 weeks (45% vs. 51%).

This post-hoc analysis of the TRANSITION trial pooled the 2 randomized groups and compared endpoint of proportion of patients on target dose, safety and tolerability of initiation of sacubitril/valsartan in newly diagnosed (de novo) (n=286) vs. previously diagnosed (n=705) HFrEF patients.

Main results

  • After 10 weeks, 56% de novo HFrEF patients received target dose of sacubitril/valsartan (97/103 mg) vs. 45% in prior HFrEF patients (P<0.001).
  • Proportion of patients on 49/51 mg or 97/103 mg sacubitril/valsartan was also higher in de novo HFrEF patients compared to prior diagnosed patients (72% vs. 63%, P=0.002).
  • There was no difference between groups for percentage patients who discontinued sacubitril/valsartan due to adverse events (3% in de novo group vs. 7% in the prior diagnosed group).
  • Most relevant adverse events were hyperkalemia, hypotension, and cardiac failure, with no difference in number of AEs between groups.
  • Use of betablockers, MRAs and diuretics were similar for both groups.
  • At week 4 and 10, NT-proBNP and hs-Troponin T were lower in de novo group vs. the prior diagnosed group (for both markers and both time points P<0.001).


In a post-hoc analysis of the TRANSITION trial, initiation of sacubitril/valsartan in de novo HFrEF patients was feasible, safe and well tolerated. Proportion of patients on target dose of sacubitril/valsartan was higher in de novo HFrEF patients when compared to prior diagnosed HFrEF patients. These results suggest that sacubitril/valsartan should be considered as a first-line therapy in de novo HFrEF stabilized after an ADHF event.

Our reporting is based on the information provided at the ESC Heart Failure 2019 congress

Watch the video by dr. Senni about this study

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