Abstract Body: Background:
Sacubitril/valsartan (Entresto) has shown survival benefits in patients with heart failure with reduced ejection fraction (HFrEF), but its role in patients with left ventricular assist devices (LVADs) remains unclear. As LVAD use continues to grow, optimizing medical therapy for this population is increasingly important. This study aimed to evaluate the long-term outcomes associated with sacubitril/valsartan use in LVAD patients using real-world data.
Methods:
We conducted a retrospective cohort study using the TriNetX US Collaborative Network, which includes electronic health records from 67 healthcare organizations. Adults with LVADs were divided into two cohorts: those who received sacubitril/valsartan (Cohort A, n=2,819) and those who did not (Cohort B, n=3,395). Propensity score matching was used to balance demographics, comorbidities, and the use of other guideline directed medical therapy for HFrEF, resulting in 964 matched patients in each cohort. Outcomes assessed over 5 years included all-cause mortality, acute kidney injury (AKI), drive-line infections, emergency room (ER) visits, and hospitalizations. Risk differences, hazard ratios (HR), and Kaplan-Meier survival curves were analyzed.
Results:
Patients in Cohort A had significantly lower 5-year mortality (25.9% vs. 43.8%; risk difference -17.8%, p<0.001; HR 0.586, p=0.003). AKI and hospitalization rates were numerically lower in Cohort A and reached significance on survival analysis (AKI HR 0.843, p=0.001; hospitalization HR 0.843, p=0.001), though not in absolute risk difference. No significant difference was observed in ER visits (p=0.49). Interestingly, drive-line infections were more common in the sacubitril/valsartan group (40.1% vs. 33.5%, p=0.003).
Conclusions:
In LVAD patients, sacubitril/valsartan was associated with a significant reduction in long-term mortality and improved survival related to AKI and hospitalization. However, a higher rate of drive-line infections was observed. These findings highlight a potential survival benefit of sacubitril/valsartan in this population, though further research is needed to understand the infection risk and confirm findings in randomized trials.