Comparison of the population of Polish patients participating in the TRANSITION study with the international population : a post-hoc analysis

Introduction: Heart failure (HF) patients discharged from a hospital are at a high risk of death and rehospitalization. Scarce data are available on the use of sacubitril / valsartan in this population in Poland. Objectives: The aim of this study was to compare the efficacy and tolerability of sacubitril / valsartan in the group of Polish patients who participated in the TRANSITION study with the patients recruited at other sites. Patients and methods: This is a post hoc secondary analysis of the TRANSITION study comparing sacubitril / valsartan initiation pre- vs postdischarge in 991 patients hospitalized for acute decompensated HF with reduced ejection fraction (HFrEF). The Polish subgroup consisted of 104 patients. Results: Significant differences were identified in the characteristics of Polish vs non-Polish populations. At baseline, the Polish population showed higher proportion of men, higher body mass index, lower heart rate, N-terminal pro–B-type natriuretic peptide and high-sensitivity troponin T levels, and significantly lower New York Heart Association class. The Polish patients were better managed in terms of implanted electrotherapy devices, percutaneous coronary interventions, and drug therapy, and were more often hospitalized. The primary end point of achieving the target dose of sacubitril / valsartan at treatment week 10 was met by 45.6% of the Polish patients and 48.4% of the non-Polish population (P = 0.61). Approximately 90% of the Polish patients received and maintained any sacubitril / valsartan dose for 2 weeks over 10-week treatment vs 87.5% of the non-Polish patients (P = 0.36). The rate of permanent sacubitril / valsartan treatment discontinuation was low in both Polish (3.9%) and non-Polish populations (6.4%) (P = 0.33). Conclusions: Sacubitril / valsartan can be used safely in the early period after an episode of acute HF both in the Polish and non-Polish patients with HFrEF, and the likelihood to achieve the maximum dose is the same despite significant differences between the studied populations.