Abstract 15567: Short-Term Effect on Cardiac Biomarkers of Initiation of Sacubitril/Valsartan in Hospitalized Patients With Heart Failure and Reduced Ejection Fraction: Results of the Transition Study

IntroductionThe benefit of sacubitril/valsartan (S/V) in patients with chronic heart failure and reduced ejection fraction (HFrEF) is associated with a reduction of biomarkers of myocardial stretch and necrosis. S/V initiation after an acute decompensation of HFrEF (ADHF) has not been studied and the impact of a pre-discharge (d/c) vs. post-d/c strategy on cardiac biomarkers is unknownHypothesisS/V initiation in the hospital after stabilization from ADHF is safe and well tolerated and results in early biomarker response.MethodsTRANSITION (NCT02661217) is a randomized, open-label study comparing S/V start pre- vs. 1-14 days post-d/c in HFrEF patients admitted for ADHF after hemodynamic stabilization. Patients were stratified by pre-admission treatmenton ACE-I, ARB, or ACE-I/ARB-naïve. Randomization occurred after hemodynamic stabilization 1:1 per stratum for initiation of S/V pre-d/c or post-d/c. NT-proBNP and cardiac troponin T were measured at randomization, discharge, 4 weeks (w) and 10w post-randomization.Results983 patients were included in the safety analysis (24% ACE-I/ARB naïve, 29% de novo HFrEF). Median NT-proBNP at randomization was 1902 pg/mL (Q1-Q3 [IQR]945-3883) in the pre-d/c arm (n=478) and 1669 pg/mL (IQR706-3577) in the post-d/c arm (n=473). At discharge, patients in the pre-d/c arm exhibited a significant reduction of NT-proBNP levels (change from randomization0.719, 95%CI0.677-0.762) which was greater than in the post-d/c arm (0.966, 95%CI0.905-1.031) (p