Sacubitril/Valsartan better than enalapril at improving health-related quality of life in HF

Health-related quality of life (HRQL) is known to be markedly reduced in patients with heart failure.Dr.Alvin Chandra and colleagues conducted a Secondary Analysis of the PARADIGM-HF Trial to examine the effects of sacubitril/valsartan on physical and social activities in patients with heart failure and reduced ejection fraction.The researchers found that sacubitril/valsartan combo leads to greater improvements in patients' physical and social activities relative to enalapril.The study has been published in JAMA Cardiology.

The secondary analysis from the industry-supported PARADIGM-HF trial infers that the combination of sacubitril & valsartan leads to greater improvements in patients' physical and social activities relative to enalapril. Sacubitril is a neprilysin inhibitor that affects natriuretic peptide levels and valsartan is an angiotensin receptor blocker.

In the main trial, roughly 8400 adults with symptomatic heart failure and reduced ejection fraction were randomized to receive sacubitril/valsartan or enalapril twice daily.In this new analysis, researchers followed the 7600 participants who completed health-related quality-of-life assessments at baseline.In the post hoc secondary analysis of 8399 patients from the Prospective Comparison of ARNI With an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial, limitations in physical and social activities were significantly improved in almost all domains in patients randomized to receive sacubitril/valsartan, compared with enalapril.

At 8 months, quality-of-life scores significantly favored sacubitril/valsartan for most outcomes measured, including walking on level ground, household chores, jogging or hurrying, and sexual relationships. The benefits of sacubitril/valsartan generally persisted at 36 months, with the greatest effect seen for sexual relationships.The largest improvement was seen in limitations of sexual activity.

The researchers concluded that in patients with heart failure with reduced ejection fraction, sacubitril/valsartan significantly improved nearly all KCCQ physical and social activities compared with enalapril, with the largest responses in household chores and sexual relationships.They say the overall improvement in scores with sacubitril/valsartan "was comparable to a difference of approximately 9 years in aging."In addition to improving morbidity and mortality, sacubitril/valsartan may significantly improve limitations in physical and social activities that are common in patients with heart failure, including sexual activities.

For more details click on the link : doi:10.1001/jamacardio.2018.0398