Impact of ARNI (angiotensin receptor neprilysin inhibitor) on functional status of patients with heart failure and reduced ejection fraction (HFREF)

Abstract

Introduction: Pharmacological measures have improved the survival and functional class among patients with heart failure. ARNI is the newest medication approved for patients with HFrEF and associated with significant improvement in survival and hospital readmissions. Functional activity can be assessed by NYHA class. Methodology: Retrospective analysis of the patients switched from ACEI/ARB to ARNI at King Fahad Medical City. Patients were regularly seen at the clinic after the initiation of ARNI. Symptoms, clinical examination and demographic and hemodynamic data were recorded at each visit along with modification and adjustment of medications. Their NYHA class were assessed before the initiation and recorded at each visit. Results: 82 patients were switched from ACEI/ARB to ARNI in last 1 year. 62% of patients were in NYHA class II and 38% of patients in NYHA III/IV. ARNI was stopped in 10 patients (7 patients due to kidney injury, hypotension and non-compliance and 3 patients expired with 15–20 days of initiation). Baseline characteristics were studied in 72 patients. Renal dysfunction was present at baseline in 35% of patients. Beta blockers were prescribed in 100% of patients (optimum dosage: 40%, 50%–<100% of optimum dosage: 44%, <50% of optimum dosage: 15%). MRA was prescribed in 54% of patients. Follow up completed for 60 patients. ARNI was titrated to optimum dosage in 58% of patients. No mortality recorded in the long term follow up. Drop in systolic BP were recorded in 58% of patients (maximum drop was of 42 mmHg and average was 19 mmHg). No worsening of renal function was noted in 42% of patients. NYHA class improved in 68% of patients (NYHA III to II: 30%, NYHA II/III to I: 38%). Conclusion: ARNI was tolerated in 88% of patients when switched from ACEI/ARB and was associated with significant improvement in NYHA class in 68% of patients.