Effects of sacubutril/valsartan on nutritional status in heart failure with reduced ejection fraction

Abstract

Background Malnutrition commonly occurs in patients with heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan, which is an AT1 neprilysin inhibitor, has been shown to reduce mortality and hospitalization in patients with HFrEF. However, its effects on nutritional status remain unclear. Methods Sacubitril/valsartan was initiated in 164 symptomatic patients with HFrEF receiving an optimal medical treatment with angiotensin inhibition (mean age: 63 +/- 20 years; 120 males, 60% ischemic cause). The New York Heart Association (NYHA) functional class and nutritional statuses of the patients were evaluated at the switching to AT1 neprilysin inhibitor and at the 6th-month follow-up of the maximum sacubitril/valsartan dose using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and prealbumin. Results After the sacubutril/valsartan treatment, a significant reduction in the number (%) of malnourished patients was observed according to CONUT (before 47% vs. after 7%,P < 0.001), GNRI (before 39% vs. after 19%,P < 0.001), PNI scores (before 36% vs. after 12%,P = 0.002), and prealbumin (before 41% vs. after 12%,P < 0.001). Also significant changes were observed at the baseline and follow-up in the mean scores of the three different nutritional indexes and prealbumin levels [CONUT: 2.68 +/- 2.5, 1.02 +/- 1.0 (P < 0.001); GNRI: 97.1 +/- 9.7, 101.2 +/- 5.9 (P < 0.001); PNI: 38.8 +/- 4.8, 41.6 +/- 3.7 (P < 0.001); prealbumin: 14.6 +/- 6.9 mg/dl, 17.1 +/- 5.2 mg/dl (P < 0.001)]. Overall, the patients exhibited a significant functional improvement following the initiation of sacubitril/valsartan: 23% of the patients improved by two NYHA classes, 48% improved by one NYHA class, and 39% remained stable. Conclusion In patients with HFrEF, the switch from angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapy to sacubitril/valsartan resulted in a significant improvement in both nutritional and functional statuses.