Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR)

Ekici, Berkay; Yaman, Mehmet; Küçük, Murathan; Dereli, Seçkin; Yenerçağ, Mustafa; Yiğit, Zerrin; Baş, Memduh; Karaveli̇oğlu, Yusuf; Çakmak, Hüseyin Altuğ; Kıvrak, Tarık; Özkan, Hakan; Altın, Cihan; Şabanoğlu, Cengiz; Demirkan, Burcu; Ataş, Ali; Kılıçaslan, Fethi; Altay, Hakan; Tengiz, İstemihan; Erkan, Aycan Fahri; Kiliçaslan, Barış; Olgun, Fatih Erkam; Durakoğlugil, Murtaza Emre; Alhan, Aslıhan; Zoghi, Mehdi

doi:10.5543/tkda.2021.63099

Cited by 10 publications

(7 citation statements)

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“…Apart from HF hospitalization and all-cause mortality, changes in NYHA functional class, LVEF, and NT-proBNP levels before and after initiation of sacubitril/valsartan were also assessed in many realworld studies. Similar to other real-world studies, 13,24,25 the three studies included in the meta-analysis also observed significant improvements in NYHA. Moreover, it was worthy of note that no obvious difference in NYHA improvement between the high-dose group and the low-dose group was found in the present metaanalysis.…”

Section: Discussionsupporting

confidence: 84%

“…4,9 Indeed, it is well known from registry data, low dose of sacubitril/valsartan is very common in real-world clinical setting due to several factors (symptomatic hypotension, hyperkalemia, renal dysfunction, and worsening HF), which was a clear difference from landmark trial. 6,[10][11][12][13] Two studies discovered that underdose of sacubitril/ valsartan was associated with a higher risk of all-cause death or HF hospitalization. 10,14 However, a retrospective cohort study found that reduced doses of sacubitril/valsartan did not increase risk of mortality or hospitalization compared with sacubitril/valsartan at the target dose.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, large proportion of patients (74.76%) achieved target dose of sacubitril/valsartan in the trial 4,9 . Indeed, it is well known from registry data, low dose of sacubitril/valsartan is very common in real‐world clinical setting due to several factors (symptomatic hypotension, hyperkalemia, renal dysfunction, and worsening HF), which was a clear difference from landmark trial 6,10–13 . Two studies discovered that underdose of sacubitril/valsartan was associated with a higher risk of all‐cause death or HF hospitalization 10,14 .…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of low‐dose sacubitril/valsartan in heart failure patients: A systematic review and meta‐analysis

Chen

Jiang

Gao

et al. 2023

Clinical Cardiology

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Background: Controversy has persisted over the clinical benefits of low-dose sacubitril/valsartan in patients with heart failure (HF).Hypothesis: Low-dose sacubitril/valsartan might also be effective and safe in HF patients.Methods: Electronic databases including PubMed, Ovid, and Cochrane Library were systematically retrieved from inception to August 5, 2021. Review manager 5.4 and Stata 15.1 were employed in this systematic review and meta-analysis. Key efficacy outcomes of interest included HF hospitalization, all-cause mortality, left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP), together with New York Heart Association (NYHA) functional class. The safety outcome was systolic blood pressure (SBP). The grading of recommendations assessment, development, and evaluation approach was conducted to evaluate the quality of evidence for each outcome.Results: A total of 1269 studies were screened and 9 real-world studies met the inclusion criteria were included in the meta-analysis, with 1697 participants. Compared with low-dose sacubitril/valsartan, high-dose sacubitril/valsartan significantly reduced the risk of HF hospitalization (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.27-0.61, p < .0001) and the risk of all-cause mortality (OR: 0.23, 95% CI: 0.11-0.47, p < .0001). However, there were no appreciable differences in improvements of NYHA

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of low‐dose sacubitril/valsartan in heart failure patients: A systematic review and meta‐analysis

Chen

Jiang

Gao

et al. 2023

Clinical Cardiology

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“…Rattanavipanon W. et al [ 10 ], in a study presenting the real-world experience of ARNI usage in Thailand on a group of 187 patients, proved that ARNI use was associated with a significant reduction of all-cause mortality and/or hospitalization for decompensated HF within 12 months. In a multicentre, noninterventional, retrospective, observational study in Turkey, where overall 779 patients with HF received ARNI, it was shown that during the use of this drug the number of hospitalizations decreased for 1 year follow-up [ 11 ]. Moreover, based on actuarial estimates of event rates and life expectancy, it is expected that ambulatory patients with HFrEF ARNI therapy will have prolonged survival by approximately 1–2 years [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

ARNI in HFrEF—One-Centre Experience in the Era before the 2021 ESC HF Recommendations

Niemiec

Morawska

Stec

et al. 2022

IJERPH

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Background: Sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor (ARNI), has demonstrated a survival benefit and reduces heart failure hospitalization in patients with heart failure with reduced left ventricular ejection fraction (HFrEF); however, our experience in this field is limited. This study aimed to summarize a real clinical practice of the use of ARNI in HFrEF patients hospitalized due to HFrEF in the era before the 2021 ESC HF recommendations, as well as assess their clinical outcome with regard to ARNI administration. Methods and Materials: Overall, 613 patients with HFrEF hospitalized in 2018–2020 were enrolled into a retrospective one-centre cross-sectional analysis. The study population was categorized into patients receiving (82/13.4%) and not-receiving (531/82.6%) ARNI. Clinical outcomes defined as rehospitalization, number of rehospitalizations, time to the first rehospitalization and death from any cause were analysed in the 1–2 year follow-up in the ARNI and non-ARNI groups, matched as to age and LVEF. Results: Clinical characteristics revealed the following differences between ARNI and non-ARNI groups: A higher percentage of cardiovascular implantable electronic devices (CIED) (p = 0.014) and defibrillators with cardiac resynchronization therapy (CRT-D) (p = 0.038), higher frequency of atrial fibrillation (p = 0.002) and history of stroke (p = 0.024) were in the ARNI group. The percentage of patients with HFrEF NYHA III/IV presented an increasing trend to be higher in the ARNI (64.1%) as compared to the non-ARNI group (51.5%, p = 0.154). Incidence of rehospitalization, number of rehospitalizations and time to the first rehospitalization were comparable between the groups. There were no differences between the numbers of deaths of any cause in the ARNI (28%) and non-ARNI (28%) groups. The independent negative predictor of death in the whole population of ARNI and non-ARNI groups was the coexistence of coronary artery disease (CAD) (beta= −0.924, HR 0.806, p = 0.011). Conclusions: Our current positive experience in ARNI therapy is limited to extremely severe patients with HFrEF. Regardless of the more advanced HF and HF comorbidities, the patients treated with ARNI presented similar mortality and rehospitalizations as the patients treated by standard therapy.

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“…Another thing to be noted is that the mean maximum tolerated dose of sacubitril/valsartan achieved in Group A (107.1 ± 67.7 mg) or Group B (97.7 ± 62.6 mg) is lower than that achieved in PARADIGM-HF trial ( 7 ). Indeed, low dose of sacubitril/valsartan is very common in real-world clinical setting due to several factors (symptomatic hypotension, hyperkalemia, renal dysfunction and worsening heart failure), which is a clear difference from landmark trial ( 23 – 27 ). In a prospective observational cohort study, even under therapy with low-dose sacubitril/valsartan (135.9 ± 75.5 mg), significant decrease in NT-proBNP concentration (from 2,495 pg/ml to 943 pg/ml, P < 0.001) and prominent increase in the LVEF (from 35.6% ± 10% to 47.% ± 14.2%, P < 0.001) were observed ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Combined treatment with sacubitril/valsartan plus dapagliflozin in patients affected by heart failure with reduced ejection fraction

Jiang

Gao

Zhang

et al. 2023

Front. Cardiovasc. Med.

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BackgroundData about real-world effects of combined therapy with sacubitril/valsartan plus dapagliflozin in patients affected by heart failure (HF) with reduced ejection fraction (HFrEF) has not been widely reported. In this article, the benefits of dapagliflozin and sacubitril/valsartan respect to improvements of cardiac function in patients with HFrEF would be investigated.MethodsHF patients prescribed sacubitril/valsartan between January 2020 and January 2022 in a tertiary teaching hospital were selected using the Computerized Patient Record System. Patients were divided into two groups according to whether they were taking dapagliflozin. Clinical parameters at baseline and during follow-up were retrospectively collected and analyzed.ResultsTotal of 136 consecutive patients were recruited for this study. 72 patients treated with sacubitril/valsartan and dapagliflozin were assigned to Group A, and another 64 patients receiving sacubitril/valsartan monotherapy were assigned to Group B. After treatment with sacubitril/valsartan plus dapagliflozin for a median follow-up period of 189 days (IQR, 180–276), significant improvements of cardiac function were achieved in Group A. Median N-terminal pro-B-type natriuretic peptide (NT-proBNP) level was significantly decreased from 2585 pg/ml (1014–3702.5) to 1260.5 pg/ml (439.8–2214.3) (P < 0.001). Mean left ventricular ejection fraction (LVEF) improved from 34.7 ± 4.6% to 39.2 ± 7.5% (P < 0.001). Mean daily dose of loop diuretics decreased from 37.1 ± 17.3 mg/day to 25.9 ± 18.5 mg/day (P < 0.001). Regarding safety, both systolic blood pressure (P = 0.002) and diastolic blood pressure (P = 0.002) significantly decreased. For patients in Group B, significant improvements in mean LVEF (P < 0.001), decreases in mean daily dose of loop diuretics (P = 0.001) and reductions in diastolic blood pressure (P = 0.023) were observed. Strikingly, both median Δ NT-proBNP (P = 0.04) and median Δ LAD (P = 0.006) in Group A were more pronounced in comparison with those seen in Group B.ConclusionsThe combined use of sacubitril/valsartan and dapagliflozin was associated with improved cardiac function in patents with HFrEF, and led to greater reductions in LAD and NT-proBNP levels compared to sacubitril/valsartan monotherapy. These findings suggest that the combination therapy may offer more potent cardiovascular benefits.

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Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR)

Cited by 10 publications

References 0 publications

Efficacy and safety of low‐dose sacubitril/valsartan in heart failure patients: A systematic review and meta‐analysis

Efficacy and safety of low‐dose sacubitril/valsartan in heart failure patients: A systematic review and meta‐analysis

ARNI in HFrEF—One-Centre Experience in the Era before the 2021 ESC HF Recommendations

Combined treatment with sacubitril/valsartan plus dapagliflozin in patients affected by heart failure with reduced ejection fraction

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