Influence of Sacubitril/Valsartan (LCZ696) on 30-Day Readmission After Heart Failure Hospitalization

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• 作者：Akshay S. Desai ; MD ; MPH^a ; Brian L. Claggett ; PhD^a ; Milton Packer ; MD^b ; Michael R. Zile ; MD^c ; Jean L. Rouleau ; MD^d ; Karl Swedberg ; MD^e ; ^f ; Victor Shi ; MD^g ; Martin Lefkowitz ; MD^g ; Randall Starling ; MD^h ; John Teerlink ; MDⁱ ; John J.V. McMurray ; MD^j ; Scott D. Solomon ; MD^a ; ^{ssolomon@rics.bwh.harvard.edu" class="auth_mail" title="E-mail the corresponding author} ; for the PARADIGM-HF Investigators
• 关键词：hospitalization ; neprilysin ; readmission ; sacubitril/valsartan
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：19 July 2016
• 年：2016
• 卷：68
• 期：3
• 页码：241-248
• 全文大小：794 K

文摘

Patients with heart failure (HF) are at high risk for hospital readmission in the first 30 days following HF hospitalization.

Objectives

This study sought to determine if treatment with sacubitril/valsartan (LCZ696) reduces rates of hospital readmission at 30-days following HF hospitalization compared with enalapril.

Methods

We assessed the risk of 30-day readmission for any cause following investigator-reported hospitalizations for HF in the PARADIGM-HF trial, which randomized 8,399 participants with HF and reduced ejection fraction to treatment with LCZ696 or enalapril.

Results

Accounting for multiple hospitalizations per patient, there were 2,383 investigator-reported HF hospitalizations, of which 1,076 (45.2%) occurred in subjects assigned to LCZ696 and 1,307 (54.8%) occurred in subjects assigned to enalapril. Rates of readmission for any cause at 30 days were 17.8% in LCZ696-assigned subjects and 21.0% in enalapril-assigned subjects (odds ratio: 0.74; 95% confidence interval: 0.56 to 0.97; p = 0.031). Rates of readmission for HF at 30-days were also lower in subjects assigned to LCZ696 (9.7% vs. 13.4%; odds ratio: 0.62; 95% confidence interval: 0.45 to 0.87; p = 0.006). The reduction in both all-cause and HF readmissions with LCZ696 was maintained when the time window from discharge was extended to 60 days and in sensitivity analyses restricted to adjudicated HF hospitalizations.

Conclusions

Compared with enalapril, treatment with LCZ696 reduces 30-day readmissions for any cause following discharge from HF hospitalization.