Sacubitril/valsartan improves physical, social activity in HFrEF
Compared with patients with HF assigned enalapril, those assigned sacubitril/valsartan improved physical and social activity limitations, according to new data from PARADIGM-HF presented at the Heart Failure Society of America Annual Scientific Meeting.
The researchers analyzed whether sacubitril/valsartan (Entresto, Novartis) improved the ability of 8,442 patients with HF with reduced ejection fraction to perform physical and social activities vs. enalapril as assessed by the Kansas City Cardiomyopathy Questionnaire at 8 months.
The physical activities assessed were dressing oneself; showering or bathing; walking 100 yards on level ground; doing housework, gardening or carrying groceries; climbing stairs; and jogging or hurrying. The social activities assessed were hobbies and recreational activities; working or doing household chores; visiting family or friends; and conducting intimate or sexual relationships, Alvin Chandra, MD, clinical fellow in radiology at Brigham and Women’s Hospital, said during a presentation.
Patients scored each activity from 0 (extremely limited) to 100 (not at all limited) at baseline and 8 months. The researchers compared scores of those assigned sacubitril/valsartan with those assigned enalapril.
“We were particularly interested in the measures of quality of life that represent limitations in activities that are common in patients with heart failure because we know that, in general, patients with heart failure have markedly reduced overall quality of life and marked limitations in both physical and social activities,” investigator Scott D. Solomon, MD, director of noninvasive cardiology at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, told Cardiology Today. “Patients with heart failure are in a similar category as patients on dialysis in terms of their overall quality of life.”
According to the researchers, those assigned sacubitril/valsartan had a greater change in score from baseline to 8 months compared with those assigned enalapril for the following activities: sexual and intimate relationships (P = .002), doing household chores (P < .001), hobbies and recreational activities (P = .001), doing yard work (P = .007), hurrying or jogging (P = .042), visiting family (P = .027) and walking one block (P = .029).
“The biggest improvements were in doing household chores and in sexual or intimate relationships, and this was true in both men and women who were randomized to sacubitril/valsartan,” Solomon said.
The researchers calculated that randomization to sacubitril/valsartan was equivalent to approximately age 9 years in terms of being able to perform physical and social activities.
“One of the most important factors in our ability to do all of these activities is how old we are,” Solomon told Cardiology Today. “The older we get, the less we are able to do activities such as climbing a flight of stairs, walking 100 yards, jogging or hurrying, doing yard work, doing household chores and engaging in sexual and intimate relationships. It turns out that the benefit we saw overall with sacubitril/valsartan was equivalent to about 9 years of life.”
Although the benefits of sacubitril/valsartan on mortality and HF hospitalization were known, the new data “help with something that patients can really appreciate, which is how they feel and what they can do,” Solomon said. “This analysis helps us tell our patients that this new drug [that] can replace the one they have been on for a while will not just help them stay out of the hospital and reduce their overall mortality risk, but will also make them feel better and do more of the kinds of activities that patients with HF are often compromised in.” – by Erik Swain
Chandra A, et al. Late-Breaking Clinical Trials. Presented at: Heart Failure Society of America Annual Scientific Meeting; Sept. 16-19, 2017; Dallas.
Disclosures: The study was funded by Novartis. Chandra reports no relevant financial disclosures. Solomon reports he has received research support from and consulted for Novartis and served as a member of the executive committee of PARADIGM-HF.