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

Abstract

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.

Comparison of the population of Polish patients participating in the TRANSITION study with the international population: a post-hoc analysis

“…Optimal therapy for patients with HFrEF also includes implantable devices. A posthoc analysis of the Polish population revealed a relatively higher proportion of patients with an implanted ICD or CRT defibrillator (CRT-D) before initiation of ARNI therapy, which was also observed in the two previously discussed studies conducted in Polish HFrEF patients [12,14]. In these studies, sacubitril/valsartan was mostly initiated in patients with advanced heart failure.…”

“…This post-hoc analysis of the Polish TRANSITION study population compared with the population from the other 18 countries provides additional information both on patient characteristics and the efficacy and safety of early sacubitril/valsartan initiation after an acute heart failure episode. This is one of the few analyses concerning the Polish experience with the use of this modern HFrEF treatment [12][13][14]. Even in the selected population of patients enrolled in the clinical trial, prior heart failure hospitalizations were significantly more frequent in the Polish population than in the non-Polish population.…”

“…In the Lelonek et al study, over a 1-year follow-up, 52% of patients received the maximum dose of ARNI [12]. Unfortunately, there are no data available on sacubitril/valsartan doses used in the Niemiec et al study [14]. In TRANSITION, more than 45% of patients in the Polish subgroup and 48% of patients in the non-Polish subgroup received the maximum sacubitril/valsartan dose of 97/103 mg bid as early as at treatment week 10.…”

Effect of sacubitril-valsartan on left ventricular remodeling and NT-proBNP in patients with heart failure complicated with hypertension and reduced ejection fraction

“…Additionally, it exhibits anti-inflammatory, anti-ventricular remodeling, and antihypertensive properties, thereby enhancing therapeutic outcomes and patient prognosis [6]. Recent studies have elucidated ARNI's role in ameliorating heart failure and its potential in blood pressure control [7]. Initially recommended as the primary treatment for heart failure with reduced ejection fraction (HFrEF), ARNI has gained approval for hypertension treatment in China based on substantial evidence [8].…”