Di-san junyi daxue xuebao (Nov 2020)
Real-world application of sacubitril/valsartan in patients suffering from heart failure with reduced ejection fraction
Abstract
Objective To observe and analyze the efficacy, the effect on cardiac structure and function and the dosage of sacubitril/valsartan (ARNI) in real clinical practice in patients with heart failure with reduced ejection fraction (HFrEF). Methods A total of 118 HFrEF patients treated with ARNI in our hospital from September 2017 to February 2020 were recruited in this study. Their clinical data before and after treatment were collected. After all of them were followed up for a median time of 8 (6 to 12) months, the changes of New York Heart Association (NYHA) classification of cardiac function and myocardial structure, and the readmission due to heart failure were analyzed retrospectively. The side effects and current situation of drug use were also observed among these patients. Results After ARNI treatment, the improvement of NYHA grade ≥1 accounted for 83.1% of the HFrEF patients, and the total effective rate of treatment was 83.1%. They obtained significantly increased left ventricular ejection fraction (LVEF) (P < 0.001), and obviously decreased left atrial anterior and posterior diameter (LAD), left ventricular end-diastolic diameter (LVEDD), right atrial left-right diameter (RA) and right ventricular left-right dimension (RV) (P < 0.001). During the follow-up period, the target dose (200 mg, bid) rate of ARNI was 3.4% and the readmission rate of heart failure was 24.6%. Adverse reactions of drugs included symptomatic hypotension (14 cases, 11.9%) and skin pruritus (2 cases, 1.7%). Conclusion Although ARNI has the problem of being maintained at low dose in clinical application, it can still significantly improve the cardiac structure and function of HFrEF patients. Symptomatic hypotension is the common adverse reaction in the use of ARNI and the main reason for the low rate of ARNI target maintenance dose.
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