Abstract 17063: Angiotensin-Neprilysin Inhibition and Renal Outcomes in Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Finnian R Mc Causland ◽  
Marty Lefkowitz ◽  
Brian Claggett ◽  
Nagesh Anavekar ◽  
MICHELE SENNI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Pooled Analysis ◽  
Renal Outcome ◽  
Patients With Heart Failure ◽  
Neprilysin Inhibition ◽  
Valsartan Group ◽  
Stage Renal Disease ◽  
End Stage ◽  
Enalapril Group

Background: In patients with heart failure, chronic kidney disease (CKD) is associated with a higher risk of renal events than in patients without CKD, irrespective of the ejection fraction. We assessed the renal effects of angiotensin/neprilysin inhibition in patients with heart failure in a pooled analysis of 13,195 patients with reduced and preserved ejection fraction. Methods: We combined data from PARADIGM-HF (LVEF eligibility≤40%; n=8,399) and PARAGON-HF (LVEF eligibility≥45%; n=4,796) in a prespecified pooled analysis. We assessed the effect of treatment (sacubitril/valsartan compared with enalapril or valsartan) on the renal composite outcome, defined as the time to first occurrence of either: ≥50% reduction in eGFR, end-stage renal disease, or death from renal causes. We also assessed the influence of therapy on eGFR slope. Results: At randomization, eGFR was 68±20 ml/min/1.73m 2 in PARADIGM-HF and 63±19 ml/min/1.73m 2 in PARAGON-HF. The composite renal outcome occurred in 70 of the 6594 patients (1.1%) in the sacubitril/valsartan group and 123 of the 6601 patients (1.9%) in the valsartan or enalapril group, with a risk reduction of 44% (HR 0.56, 95%CI 0.42-0.75; P<0.001). The treatment effect on the composite renal endpoint did not differ according to the baseline eGFR (<60 vs ≥ 60 ml/min/1.73 m 2 ; P-interaction=0.46) or baseline ejection fraction (P-interaction=0.35). From randomization, the mean decline in eGFR was -1.8 (95%CI -1.9 to -1.7) ml/min/1.73 m 2 per year for the sacubitril/valsartan group, compared with -2.4 (95%CI -2.5 to -2.2) ml/min/1.73 m 2 per year for the valsartan or enalapril group, with an adjusted mean difference of 0.6 (95%CI 0.4 to 0.7; P<0.001) ml/min/1.73 m 2 per year. Conclusions: In patients with heart failure, sacubitril/valsartan reduced the risk of renal events, and slowed decline in eGFR, compared with valsartan or enalapril, across the spectrum of ejection fraction.

scholarly journals Angiotensin-Neprilysin Inhibition and Renal Outcomes in Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (13) ◽  
pp. 1236-1245 ◽  
Author(s):  
Finnian R. Mc Causland ◽  
Martin P. Lefkowitz ◽  
Brian Claggett ◽  
Nagesh S. Anavekar ◽  
Michele Senni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Renal Outcome ◽  
Preserved Ejection Fraction ◽  
Double Blind ◽  
Prospective Comparison ◽  
Patients With Heart Failure ◽  
Neprilysin Inhibition

Background: In patients with heart failure, chronic kidney disease is common and associated with a higher risk of renal events than in patients without chronic kidney disease. We assessed the renal effects of angiotensin/neprilysin inhibition in patients who have heart failure with preserved ejection fraction enrolled in the PARAGON-HF trial (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction). Methods: In this randomized, double-blind, event-driven trial, we assigned 4822 patients who had heart failure with preserved ejection fraction to receive sacubitril/valsartan (n=2419) or valsartan (n=2403). Herein, we present the results of the prespecified renal composite outcome (time to first occurrence of either: ≥50% reduction in estimated glomerular filtration rate (eGFR), end-stage renal disease, or death from renal causes), the individual components of this composite, and the influence of therapy on eGFR slope. Results: At randomization, eGFR was 63±19 mL·min –1 ·1.73 m – 2. At study closure, the composite renal outcome occurred in 33 patients (1.4%) assigned to sacubitril/valsartan and 64 patients (2.7%) assigned to valsartan (hazard ratio, 0.50 [95% CI, 0.33–0.77]; P =0.001). The treatment effect on the composite renal end point did not differ according to the baseline eGFR (<60 versus ≥60 mL·min –1 ·1.73 m –2 ( P -interaction=0.92). The decline in eGFR was less for sacubitril/valsartan than for valsartan (–2.0 [95% CI, –2.2 to –1.9] versus –2.7 [95% CI, –2.8 to –2.5] mL·min –1 ·1.73 m –2 per year). Conclusions: In patients with heart failure with preserved ejection fraction, sacubitril/valsartan reduced the risk of renal events, and slowed decline in eGFR, in comparison with valsartan. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920711.

scholarly journals Efficacy of Dapagliflozin on Renal Function and Outcomes in Patients with Heart Failure with Reduced Ejection Fraction: Results of DAPA-HF

Circulation ◽  
2020 ◽  
Author(s):  
Pardeep S. Jhund ◽  
Scott D. Solomon ◽  
Kieran F. Docherty ◽  
Hiddo J.L. Heerspink ◽  
Inder S. Anand ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Kidney Function ◽  
Adverse Outcomes ◽  
Renal Outcome ◽  
Pharmacological Management ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Rate Of Decline

Background: Many patients with heart failure and reduced ejection fraction (HFrEF) have chronic kidney disease (CKD) which complicates pharmacological management and is associated with worse outcomes. We assessed the safety and efficacy of dapagliflozin in patients with HFrEF, according to baseline kidney function, in the Dapagliflozin and Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF). We also examined the effect of dapagliflozin on kidney function after randomization. Many patients with heart failure and reduced ejection fraction (HFrEF) have chronic kidney disease (CKD) which complicates pharmacological management and is associated with worse outcomes. We assessed the safety and efficacy of dapagliflozin in patients with HFrEF, according to baseline kidney function, in the Dapagliflozin and Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF). We also examined the effect of dapagliflozin on kidney function after randomization. Methods: HFrEF patients with or without type 2 diabetes and an estimated glomerular filtration rate (eGFR) ≥30 ml/min/1.73m 2 were enrolled in DAPA-HF. We calculated the incidence of the primary outcome (CV death or worsening HF) according to eGFR category at baseline (<60 and ≥60 ml/min/1.73m 2 ) as well as using eGFR at baseline as a continuous measure. Secondary cardiovascular outcomes and a pre-specified composite renal outcome (≥ 50% sustained decline eGFR, end stage renal disease (ESRD) or renal death) were also examined, along with decline in eGFR over time. Results: Of 4742 with a baseline eGFR, 1926 (41%) had eGFR <60 ml/min/1.73m 2 . The effect of dapagliflozin on the primary and secondary outcomes did not differ by eGFR category or examining eGFR as a continuous measurement. The hazard ratio (95% confidence interval (CI)) for the primary endpoint in patients with CKD was 0.71 (0.59, 0.86) vs. 0.77 (0.64, 0.93) in those with an eGFR ≥60 ml/min/1.73m 2 (interaction p=0.54). The composite renal outcome was not reduced by dapagliflozin (HR=0.71, 95% CI 0.44, 1.16; p=0.17) but the rate of decline in eGFR between day 14 and 720 was less with dapagliflozin, -1.09 (-1.41, -0.78) vs. placebo -2.87 (-3.19, -2.55) ml/min/1.73m 2 per year (p<0.001). This was observed in those with and without type 2 diabetes (p for interaction=0.92) Conclusions: Baseline kidney function did not modify the benefits of dapagliflozin on morbidity and mortality in HFrEF and dapagliflozin slowed the rate of decline in eGFR, including in patients without diabetes. Clinical Trial Registration: https://clinicaltrials.gov Unique Identifier: NCT03036124

Abstract 12810: Beta Blockers and Mortality Benefit in Patients With Heart Failure and End Stage Renal Disease on Hemodialysis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chakradhari Inampudi ◽  
Vlad Cotarlan
Keyword(s):  
Heart Failure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Beta Blockers ◽  
Systolic Heart Failure ◽  
Mortality Benefit ◽  
Survival Curves ◽  
Patients With Heart Failure ◽  
Stage Renal Disease ◽  
End Stage

Background: Post-hoc analysis of Randomized control trials have established safety and efficacy of Beta blockers (BB) in patients with systolic heart failure (HF) and mild to moderate Chronic kidney disease (CKD). However, the mortality benefit in patients with advanced CKD especially those approaching end stage renal disease (ESRD) is limited. The study was sought to identify mortality benefit in patients with Heart failure (HF) and ESRD who progressed to dialysis. Methods: Using electronic medical records, we identified 1,817 patients with end stage renal dialysis(ESRD) who progressed to dialysis over a 6 year period between 2004 and 2011. Kaplan Meyer survival curves were used to assess the association between BB use and mortality. Results: Of 1817 patients (mean age 61+/-15, 57% males) with ESRD who progressed to dialysis, 1329 (73.1%) were treated with BB and 488 (26.5%) were never treated with a BB. Kaplan Meyer Survival curves showed that patients who received treatment with BB had better survival than patients who were never treated with BB despite more HTN and diabetes present in the former group (mean survival time 4.9 years versus 4.4 years, p<0.001, Fig 1). Survival graphs were similar for those with an encounter diagnosis of HF (n=547, Fig 2) and those without an encounter diagnosis of HF (n=1270, graph not shown) with stronger association between BB and survival among those with HF (mean survival 3.1 versus 4.8 years, p=0.001, Fig 2). Conclusion: Treatment with BB is associated with improved survival in heart failure patients with ESRD who progressed to dialysis.

scholarly journals Sacubitril/valsartan in patients with heart failure with reduced ejection fraction with end‐stage of renal disease

2020 ◽  
Vol 7 (3) ◽  
pp. 1125-1129 ◽  
Author(s):  
Seonhwa Lee ◽  
Jaewon Oh ◽  
Hyoeun Kim ◽  
Jaehyung Ha ◽  
Kyeong‐hyeon Chun ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Renal Disease ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
End Stage

scholarly journals Impact of Heart Failure on Patients Undergoing Major Noncardiac Surgery

2008 ◽  
Vol 108 (4) ◽  
pp. 559-567 ◽  
Author(s):  
Bradley G. Hammill ◽  
Lesley H. Curtis ◽  
Elliott Bennett-Guerrero ◽  
Christopher M. O'Connor ◽  
James G. Jollis ◽  
...  
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Operative Mortality ◽  
Noncardiac Surgery ◽  
Fee For Service ◽  
Cardiovascular Comorbidities ◽  
Hazard Ratios ◽  
Patients With Heart Failure ◽  
Stage Renal Disease ◽  
End Stage

Background Changes in the demographics and epidemiology of patients with cardiovascular comorbidities who undergo major noncardiac surgery require an updated assessment of which patients are at greater risk of mortality or readmission. The authors evaluated short-term outcomes among patients with heart failure, coronary artery disease (CAD), or neither who underwent major noncardiac surgery. Methods Patients were aged 65 and older, had Medicare fee-for-service coverage, and underwent 1 of 13 major noncardiac procedures from 2000 through 2004, excluding patients with end-stage renal disease and patients who did not have at least 1 yr of Medicare fee-for-service eligibility before surgery. Main outcome measures were operative mortality and 30-day all-cause readmission. Results Of 159,327 procedures, 18% were performed in patients with heart failure and 34% were performed in patients with CAD. Adjusted hazard ratios of mortality and readmission for patients with heart failure, compared with patients with neither heart failure nor CAD, were 1.63 (95% confidence interval, 1.52-1.74) and 1.51 (95% confidence interval, 1.45-1.58), respectively. Adjusted hazard ratios of mortality and readmission for patients with CAD, compared with patients with neither heart failure nor CAD, were 1.08 (95% confidence interval, 1.01-1.16) and 1.16 (95% confidence interval, 1.12-1.20), respectively. These effects were statistically significant. Patients with heart failure were at significantly higher risk for both outcomes compared with patients with CAD. Conclusions Elderly patients with heart failure who undergo major surgical procedures have substantially higher risks of operative mortality and hospital readmission than other patients, including those with coronary disease, admitted for the same procedures. Improvements in perioperative care are needed for the growing population of patients with heart failure undergoing major noncardiac surgery.

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