CANCARE RESEARCH
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An automated research-discovery feed. Summaries are based on published abstracts and are not clinical recommendations.
Clinical outcomes of sacubitril/valsartan in patients with mildly reduced or preserved ejection fraction and acute heart failure: a multi-institutional study.
Clinical takeaway Sacubitril/valsartan initiation was not associated with fewer HF rehospitalizations or cardiovascular deaths than ARB therapy in this cohort. The confidence interval does not establish equivalence.
Summary & abstract
Study summary
This observational cohort included 9,107 patients hospitalized for acute heart failure with mildly reduced or preserved ejection fraction and used propensity score overlap weighting. Comparing in-hospital sacubitril/valsartan initiation with ARB therapy, rates of HF rehospitalization or cardiovascular death were 39.7 versus 40.3 per 100 person-years (hazard ratio 0.97; 95% confidence interval 0.79–1.20). Associations were consistent across kidney-function strata, including dialysis. Greater NT-proBNP reduction in a biomarker subcohort did not translate into an observed reduction in clinical events, and limited sample size prevented conclusions of therapeutic equivalence.
Study limitation: The observational design leaves potential residual confounding despite overlap weighting, and limited sample size precludes definitive equivalence conclusions.
Published abstract
BACKGROUND: The long-term real-world effectiveness and safety of in-hospital initiation of sacubitril/valsartan in patients hospitalized for acute heart failure (HF) with mildly reduced or preserved left ventricular ejection fraction (HFmrEF or HFpEF) remain uncertain, particularly among patients with advanced chronic kidney disease or dialysis, who are often underrepresented in randomized trials. PATIENTS/MATERIALS AND METHODS: We identified 9,107 patients with HFmrEF or HFpEF hospitalized for acute HF from the Chang Gung Research Database between January 1, 2016, and June 30, 2023. Propensity score weighting with overlap weights was applied to balance baseline characteristics between treatment groups. Risks of fatal and nonfatal outcomes were analyzed using Cox proportional hazards and Fine-Gray subdistribution hazard models, respectively. RESULTS: After overlap weighting, the incidence rates of the composite endpoint of HF rehospitalization and cardiovascular (CV) death were 39.7 and 40.3 per 100 person-years in the angiotensin receptor neprilysin inhibitor (ARNI) and angiotensin receptor blocker (ARB) groups, respectively (Hazard ratio, 0.97; 95% confidence interval, 0.79-1.20). In analyses stratified by chronic kidney disease stage, the association between treatment group and the primary endpoint was consistent among patients with eGFR ≥60, 30-59, <30 mL/min/1.73 m2, or dialysis. CONCLUSIONS: In this multi-institutional real-world cohort of patients hospitalized for acute HF with left ventricular ejection fraction (LVEF) >40%, in-hospital initiation of sacubitril/valsartan was not associated with lower risks of HF rehospitalization or CV death compared with ARB therapy, despite greater NT-proBNP reduction in a biomarker subcohort. Limited sample size precludes definitive conclusions regarding therapeutic equivalence.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Association between early intravenous magnesium sulfate administration and mortality according to systemic immune-inflammation index in critically ill patients with acute heart failure: A retrospective cohort study.
Clinical takeaway Early intravenous magnesium was associated with lower mortality in this ICU acute heart failure cohort. The observational findings do not establish benefit, and interaction testing did not support differential associations across inflammatory-index strata.
Summary & abstract
Study summary
This retrospective MIMIC-IV cohort included 4,293 critically ill patients with acute heart failure; 1,561 received intravenous magnesium sulfate. Early administration meant initiation from six hours before to 24 hours after ICU admission. Compared with no early administration, magnesium was associated with lower 30-day mortality (adjusted hazard ratio 0.68, 95% confidence interval 0.56–0.82) and 90-day mortality (0.74, 0.63–0.86). Associations appeared strongest at the extremes of the systemic immune-inflammation index, but formal interaction testing was not significant. These subgroup findings are hypothesis-generating and require prospective validation.
Study limitation: Retrospective exposure comparisons remain vulnerable to confounding; exploratory subgroup patterns were not supported by significant interaction testing.
Published abstract
BACKGROUND: Magnesium sulfate is commonly administered in acute heart failure (AHF). We investigated the association between early intravenous magnesium sulfate and mortality across baseline systemic immune-inflammation index (SII) strata in critically ill patients with AHF. METHODS: We conducted a retrospective study using the MIMIC-IV database of critically ill patients with AHF. Early intravenous magnesium sulfate was defined as treatment initiated from 6 h before to 24 h after intensive care unit admission. SII was categorized into quartiles. The primary and secondary outcomes were 30-day and 90-day all-cause mortality. Multivariable Cox regression, restricted cubic spline, and sensitivity analyses were performed. RESULTS: Among 4293 patients, 1561 (36.4%) received intravenous magnesium sulfate. Magnesium sulfate administration was associated with lower 30-day (adjusted hazard ratio [aHR] 0.68, 95% CI 0.56-0.82) and 90-day mortality (aHR 0.74, 95% CI 0.63-0.86). For 30-day mortality, multivariable Cox regression demonstrated significant associations in the lowest (aHR 0.64, 95% CI 0.43-0.95) and highest (aHR 0.52, 95% CI 0.36-0.75) SII quartiles, whereas no significant associations were identified in the intermediate quartiles. Comparable patterns were observed for 90-day mortality. Restricted cubic spline analyses showed visual separation between treatment groups at the extremes of the SII distribution, although formal interaction testing was not significant. Sensitivity analyses consistently reproduced the association in the highest SII quartile. CONCLUSIONS: Stratified analyses suggested that the association between early magnesium sulfate administration and lower mortality was most evident in the highest SII quartile and less consistent in the lowest quartile. These findings are hypothesis-generating and require prospective validation. TRIAL REGISTRATION: Not applicable.
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