■随机临床试验表明,沙库巴曲-缬沙坦可降低射血分数(HFrEF)降低的心力衰竭患者的死亡率和住院风险,但需要透析的肾衰竭患者被排除在外.
■研究沙库巴曲缬沙坦与血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂(ACEI或ARB)在需要血液透析的HFrEF患者中的比较有效性。
■这次回顾展,1:1倾向评分匹配的比较有效性研究包括18岁或以上患有HFrEF的患者,参加医疗保险A部分,B,D,从2015年7月8日至2020年12月31日接受中心血液透析至少存活90天。患者被排除在少于180天的连续医疗保险A部分,B,和D主要付款人承保或事先分配沙库巴曲-缬沙坦。数据分析于2023年9月23日至2024年6月25日进行。
■沙库巴曲-缬沙坦的新用途与ACEI或ARB的新用途或持续用途。
■开始沙库巴曲-缬沙坦治疗与全因死亡率之间的关系,心血管死亡率,全因住院,在倾向评分匹配的样本中,使用Cox比例风险回归模型评估HF住院率.
■参与者包括1:1配对的1434名沙库比曲-缬沙坦使用者和1434名ACEI或ARB使用者(平均[SD]年龄,64[13]年)。在2868名匹配的参与者中,996(65%)为男性;987(34%)为黑人或非裔美国人,1677(58%)为白人;透析年份中位数为3.8(IQR,1.8-6.3)年。中位随访时间为0.9(IQR,0.4-1.7)年。sacubitril-valsartan(vsACEI或ARB)治疗与全因死亡率降低相关(风险比[HR],0.82[95%CI,0.73-0.92])和全因住院(HR,0.86[95%CI,0.79-0.93]),但不是心血管死亡率(HR,1.01[95%CI,0.86-1.19])或HF住院(HR,0.91[95%CI,0.82-1.02])。高钾血症(HR,0.71[95%CI,0.62-0.81]),低血压无差异(HR,0.99[95%CI,0.83-1.19])。只有195名参与者(14%)接受过沙库必曲(97mg,每日两次)和缬沙坦(103mg,每日两次)的最大组合剂量。
■在这项需要血液透析的HFrEF患者的有效性比较研究中,沙库巴曲-缬沙坦治疗与全因死亡率和全因住院的有益效果相关.
UNASSIGNED: Randomized clinical trials have shown that sacubitril-
valsartan reduces the risks of mortality and hospitalization in patients with heart failure with reduced ejection fraction (HFrEF), but patients with kidney failure requiring dialysis were excluded.
UNASSIGNED: To investigate the comparative effectiveness of sacubitril-valsartan vs angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs or ARBs) in patients with HFrEF requiring hemodialysis.
UNASSIGNED: This retrospective, 1:1 propensity score-matched comparative effectiveness study included patients who were 18 years or older with HFrEF, enrolled in Medicare Parts A, B, and D, and survived at least 90 days receiving in-center hemodialysis from July 8, 2015, to December 31, 2020. Patients were excluded for less than 180 days of continuous Medicare Parts A, B, and D primary payer coverage or prior dispensing of sacubitril-valsartan. Data analysis was conducted from September 23, 2023, to June 25, 2024.
UNASSIGNED: New use of sacubitril-
valsartan vs new or continued use of ACEIs or ARBs.
UNASSIGNED: The associations between initiation of sacubitril-
valsartan therapy and all-cause mortality, cardiovascular mortality, all-cause hospitalization, and HF hospitalization were assessed using Cox proportional hazards regression models in a propensity score-matched sample.
UNASSIGNED: Participants included 1:1 matched pairs of 1434 sacubitril-
valsartan users and 1434 ACEI or ARB users (mean [SD] age, 64 [13] years). Of the 2868 matched participants, 996 (65%) were male; 987 (34%) were Black or African American and 1677 (58%) were White; and median dialysis vintage was 3.8 (IQR, 1.8-6.3) years. The median follow-up was 0.9 (IQR, 0.4-1.7) years. Sacubitril-
valsartan (vs ACEI or ARB) therapy was associated with a reduction in all-cause mortality (hazard ratio [HR], 0.82 [95% CI, 0.73-0.92]) and all-cause hospitalization (HR, 0.86 [95% CI, 0.79-0.93]) but not cardiovascular mortality (HR, 1.01 [95% CI, 0.86-1.19]) or HF hospitalization (HR, 0.91 [95% CI, 0.82-1.02]). There was a decrease in hyperkalemia (HR, 0.71 [95% CI, 0.62-0.81]) and no difference in hypotension (HR, 0.99 [95% CI, 0.83-1.19]). Only 195 participants (14%) ever received the maximum combination dose of sacubitril (97 mg twice daily) and valsartan (103 mg twice daily).
UNASSIGNED: In this comparative effectiveness study of patients with HFrEF requiring hemodialysis, sacubitril-valsartan therapy was associated with beneficial effects in all-cause mortality and all-cause hospitalization.