Sacubitril/Valsartan Versus Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy: Rehospitalization Outcomes in a Predominantly Hispanic Population With Heart Failure

BackgroundHeart failure (HF) remains a major cause of hospitalization and rehospitalization.Although sacubitril/valsartan has demonstrated improved outcomes in patients with HF with reduced ejection fraction, evidence regarding its use and rehospitalization outcomes in Hispanic populations remains limited.This study evaluated rehospitalization outcomes and compared clinical outcomes between patients receiving sacubitril/valsartan and those receiving angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy in a predominantly Hispanic population in Puerto Rico. MethodsWe conducted a retrospective cohort study of 419 adults hospitalized with HF at a tertiary care center in Puerto Rico between January 2022 and June 2025.Medication exposure was assessed at index admission and subsequent readmission.Outcomes included HF-related rehospitalization, length of stay (LOS), recurrent hospitalization frequency, and time between admissions.We also evaluated outcomes among patients who transitioned from ACEi/ARB therapy to sacubitril/valsartan between hospitalizations. ResultsPatients receiving sacubitril/valsartan had a higher proportion of left ventricular ejection fraction (LVEF) <41% than those receiving ACEi/ARB therapy at index admission (65% vs 40%) and readmission (52% vs 38%).The observed readmission proportion was lower with sacubitril/valsartan than with ACEi/ARB therapy (37% vs 40%; relative risk, 0.88), but the difference was not statistically significant (p = 0.596).Mean LOS was longer with sacubitril/valsartan at index admission (7.5 vs 5 days) and shorter at readmission (6 vs 7 days).Among patients initially receiving ACEi/ARB therapy, those who subsequently transitioned to sacubitril/valsartan had fewer mean readmissions (2.6 vs 3.1; p = 0.534) and a longer mean interval between admissions (538 vs 463 days; p = 0.283); neither difference was statistically significant. ConclusionsSacubitril/valsartan was used in patients with a higher prevalence of reduced ejection fraction and showed numerically favorable rehospitalization outcomes with ACEi/ARB therapy, although differences were not statistically significant.