Table 3.
Projected Canadian outcomes at 1 year in the Canadian population with different heart failure (HF) with reduced ejection fraction pharmacotherapy sequencing strategies
| Strategy | HF hospitalization or CV death, incidence, %∗ | Death |
||
|---|---|---|---|---|
| Incidence, %∗ | Projected deaths with 100% adherence† | Projected deaths with 75% adherence† | ||
| No treatment | 28.0 | 13.9 | ∼7600 | ∼7600 |
| Traditional (ACEI → beta-blocker → MRA → ACEIΔARNI → SGLT2i; 24 wk) |
12.9 | 6.5 | ∼3600 (–4000 vs no treatment) | ∼4600 (–3000 vs no treatment) |
| Faster traditional (ACEI → beta-blocker → MRA → ACEIΔARNI → SGLT2i; 16 wk) | 10.6 | 5.8 | ∼3100 (–500 vs traditional) | ∼4200 (–400 vs traditional) |
| Direct ARNI (ARNI → beta-blocker → MRA → SGLT2i; 12 wk) |
9.8 | 5.7 | ∼3000 (–600 vs traditional) | ∼4100 (–500 vs traditional) |
| MRA- or SGLT2i-first (and incorporating direct ARNI into the sequence) (Various; 12 wk) |
8.2 to 8.7 | 5.2 to 5.3 | ∼2800 (–800 vs traditional) | ∼4000 (–600 vs traditional) |
| Starting with dual therapy (and incorporating direct ARNI into the sequence) (Various; 8–12 wk) |
7.7 to 8.2 | 5.0 to 5.1 | ∼2700 (–900 vs traditional) | ∼3900 (–700 vs traditional) |
ACEI, angiotensin-converting enzyme inhibitor; ARNI, angiotensin receptor-neprilysin inhibitor; CV, cardiovascular; MRA, mineralocorticoid receptor antagonist; SGLT2i, sodium-glucose cotransporter-2 inhibitor.
∗
Estimates from the modeling study by Shen et al.22
†
Projected Canadian population-level benefits calculated based on the 2017 crude incidence of 106,500 new HF cases in Canada, a prevalence of HF with reduced ejection fraction of ∼50% among all HF cases, and assuming 100% (optimistic) and 75% (pessimistic) adherence to medication regimens.