Dose titration of sacubitril/valsartan for heart failure with reduced ejection fraction: a real-world study

被引:11
作者
Wang, Chen
Lin, Zongwei
Miao, Dongxia
Zhang, Hui
Fu, Kang
Zhang, Xinyu
Xiao, Jie
Hu, Yue
Sun, Yijun
Wang, Fen
Lu, Huixia [1 ,2 ]
Ji, Xiaoping [1 ,2 ]
机构
[1] Shandong Univ, Qilu Hosp, Cheeloo Coll Med, Key Lab Cardiovasc Remodeling & Funct Res,Minist E, Jinan 250012, Shandong, Peoples R China
[2] Shandong Univ, Qilu Hosp, Cheeloo Coll Med, Dept Cardiol,Chinese Acad Med Sci,State & Shandon, Jinan 250012, Shandong, Peoples R China
来源
ESC HEART FAILURE | 2023年 / 10卷 / 03期
基金
中国国家自然科学基金;
关键词
Heart failure; Sacubitril; valsartan; Dose titration; Management; Ventricular remodelling; ENALAPRIL;
D O I
10.1002/ehf2.14367
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
AimsThe study aims to explore the real-world titration patterns of sacubitril/valsartan in a chronic heart failure (HF) follow-up management system and the effect on the recovery of ventricular remodelling and cardiac function in China. Methods and resultsThis is a single-centre, observational study of 153 adult outpatients with HF and reduced ejection fraction who were managed in the chronic HF follow-up management system and prescribed with sacubitril/valsartan from August 2017 to August 2021 in China. All patients tried to titrated sacubitril/valsartan to the tolerant dose during follow-up. The primary outcome was the proportion of patients who reached and maintained the target dose of sacubitril/valsartan. The main secondary outcomes were the changes in left atrium diameter, left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) from baseline to 12 months. Among the patients, 69.3% were male, with a median age of 49 years. The baseline systolic blood pressure (SBP) was 117.6 +/- 18.3 mmHg before starting the treatment of sacubitril/valsartan. Benefiting from the management system, 117 (76.5%) patients achieved the target dose of sacubitril/valsartan, and the median time to reach the target dose was 3 (IQR 1-5) months. Advanced age and lower SBP may be predictors of failure to reach the target dose. Compared with baseline, standard treatment resulted in a pronounced improvement in left ventricular geometry and cardiac function. The patients showed a significant increase in LVEF [28 (IQR 21-34) % vs. 42 (IQR 37.0-54.3) %, P < 0.001], with a great reduction in left atrium diameter [45 (IQR 40.3-51.0) mm vs. 41 (IQR 37.0-45.3) mm, P < 0.001] and LVEDD [65 (IQR 60.0-70.3) mm vs. 55 (IQR 52-62) mm, P < 0.001] during 12 month follow-up. Of patients, 36.5% had a LVEF >= 50%, 54.1% had LVEF >40%, and 81.1% experienced an increase in LVEF of >= 10%. After 12 month follow-up, the proportion of patients with New York Heart Association classification I or II increased from 41.8% to 96.4%. Additionally, there was a significant improvement in N-terminal pro-B-type natriuretic peptide (P < 0.001). At Month 12, 50% of patients achieved the target dose of beta-blockers. No serious adverse events caused by sacubitril/valsartan were observed during the follow-up. ConclusionsOptimising HF follow-up management was essential and effective in a real-world clinical setting; the majority could reach the target dose of sacubitril/valsartan within the management system and achieve a remarkable improvement in cardiac function and ventricular remodelling.
引用
收藏
页码:1961 / 1971
页数:11
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