AI Article Synopsis
- - The study aimed to evaluate the effectiveness and safety of low-dose sacubitril/valsartan in heart failure patients, particularly compared with high doses.
- - A systematic review of 1269 studies resulted in 9 real-world studies being included, involving 1697 participants, showing that high-dose sacubitril/valsartan significantly reduces the risk of heart failure hospitalization and all-cause mortality.
- - Despite the increased risks associated with low-dose sacubitril/valsartan, there were no notable differences in other health outcomes like NYHA functional class, left ventricular ejection fraction, NT-proBNP levels, or systolic blood pressure between low and high doses.
Article Abstract
Background: Controversy has persisted over the clinical benefits of low-dose sacubitril/valsartan in patients with heart failure (HF).
Hypothesis: Low-dose sacubitril/valsartan might also be effective and safe in HF patients.
Methods: Electronic databases including PubMed, Ovid, and Cochrane Library were systematically retrieved from inception to August 5, 2021. Review manager 5.4 and Stata 15.1 were employed in this systematic review and meta-analysis. Key efficacy outcomes of interest included HF hospitalization, all-cause mortality, left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP), together with New York Heart Association (NYHA) functional class. The safety outcome was systolic blood pressure (SBP). The grading of recommendations assessment, development, and evaluation approach was conducted to evaluate the quality of evidence for each outcome.
Results: A total of 1269 studies were screened and 9 real-world studies met the inclusion criteria were included in the meta-analysis, with 1697 participants. Compared with low-dose sacubitril/valsartan, high-dose sacubitril/valsartan significantly reduced the risk of HF hospitalization (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.27-0.61, p < .0001) and the risk of all-cause mortality (OR: 0.23, 95% CI: 0.11-0.47, p < .0001). However, there were no appreciable differences in improvements of NYHA (OR: 0.59, 95% CI: 0.15-2.35, p = .45), changes of LVEF (mean difference [MD]: 2.73%, 95% CI: -2.24% to 7.7%, p = .28), changes of NT-proBNP (MD: 43.09, 95% CI: -28.41 to 114.59, p = .24) and changes of SBP (MD: 3.01, 95% CI: -4.62 to 10.64, p = .44) between groups with low-dose and high-dose sacubitril/valsartan.
Conclusions: Compared with high-dose sacubitril/valsartan, low-dose sacubitril/valsartan was associated with increased risks of HF hospitalization and all-cause mortality. However, no distinct between-group differences in improvements of NYHA, changes of LVEF, changes of NT-proBNP and changes of SBP were observed.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10018087 | PMC |
| http://dx.doi.org/10.1002/clc.23971 | DOI Listing |
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