Gregg C. Fonarow
In a real-world prospective cohort, patients with HF with reduced ejection fraction receiving sacubitril/valsartan had improved quality of life and less frequent symptoms than patients not receiving the medication, according to findings from the CHAMP-HF registry.
Researchers analyzed 365 patients started on sacubitril/valsartan (Entresto, Novartis) matched with 730 patients receiving a different oral pharmacotherapy for HF and presented their findings at Heart Failure 2018 & World Congress on Acute Heart Failure.
All patients (30% women; 44% aged 40-64 years; 43% aged 65-80 years) took the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline, 1, 3, 6, 12, 18 and 24 months. The questionnaire measures four domains: physical limitation, frequency and severity of symptoms, social limitation and quality of life.
“Health status as defined by the Kansas City Cardiomyopathy Questionnaire is a really important patient-centered outcome, but is rarely studied outside of randomized clinical trials,” Gregg C. Fonarow, MD, director of Ahmanson-UCLA Cardiomyopathy Center, co-director of UCLA preventive cardiology program, co-chief of the division of cardiology at UCLA and the Eliot Corday Chair in Cardiovascular Medicine and Science, told Cardiology Today. “We were interested in the association of use of this medication with patients’ health status in real-world clinical practice. We wanted to get a sense of how it worked in clinical practice beyond the expected reductions in mortality and hospitalization risk.”
At a median 32 days of follow-up, compared with patients assigned a different medication, patients receiving sacubitril/valsartan had a greater change from baseline in overall KCCQ score (6.01 vs. 3.55; P = .014), symptom frequency score (5.07 vs. 1.6; P = .007) and quality-of-life score (7.53 vs. 4.09; P = .021), according to the researchers.
“It is notable that overall and in several specific domains, there were clinically meaningful improvements in health status” associated with sacubitril/valsartan, Fonarow said in an interview.
There were no significant differences in change in physical limitation score or social limitation score.
A change of at least 20 points in symptom frequency score occurred in 20.3% of the sacubitril/valsartan group and 15.2% of the other-medication group, whereas a change of at least 20 points in quality-of-life score occurred in 27.4% of the sacubitril/valsartan group and 24% of the other-medication group, according to the researchers.
“These findings tell us that in clinical practice, there were meaningful, clinically relevant and early improvements in health status,” Fonarow said.
Although guidelines already recommend sacubitril/valsartan for reduction of mortality and HF hospitalization risk, “patients want to know if starting this therapy will be associated with them feeling better,” Fonarow told Cardiology Today. “This study suggests that within 3 months, a significant proportion of patients experience meaningful improvements in health status compared with conventional therapies. This is an additional reason to follow the very strong guideline recommendations.” – by Erik Swain
Khariton Y, et al. Late-breaking trial IV: Registries. Presented at: Heart Failure 2018 & World Congress on Acute Heart Failure; May 26-29, 2018; Vienna.
Disclosure: The study was funded by Novartis. Fonarow reports he served as a consultant for Novartis.