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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Eligibility for sacubitril-valsartan in a real-world heart failure population: an hospital-based single-centre evaluation.
Session:
Posters 2 - Écran 7 - Insuficiência Cardíaca
Speaker:
Joao Tavares
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters
FP Number:
---
Authors:
João Galaz Tavares; Vanessa Novais de Carvalho; Luís Mão De Ferro Landeiro; Ines Rodrigues; Pedro Moraes Sarmento
Abstract
<p>The most recent ESC Guidelines in heart failure recommend the use of sacubitrilvalsartan in patients with heart failure and reduced ejection fraction (HFrEF) that remain symptomatic regardless of ACE inhibitor, betablocker and mineralocorticoid receptor antagonist optimized treatment. The hospitalized heart failure patient is the paradigm of such a patient that regardless of the NYHA Class before and after discharge fulfils this criterion.</p> <p>AIMS: To identify the proportion of hospitalized patients with heart failure and reduced ejection fraction eligible for sacubitril-valsartan at the time of discharge in clinical practice. To characterize de differences between patients accordingly to the eligibility.</p> <p>METHODS: Medical records of all heart failure patients consecutively admitted, between January and December 2017, to a private university hospital were assessed. Demographic data, heart failure type and aetiology, comorbidities, causes of decompensation and ongoing treatment at admission were evaluated. Patients with reduced ejection fraction (≤35%), under current treatment with or withoutntarget doses of ACE inhibitors or ARBs and betablocker at admission, with eGFR>30 ml/min and systolic blood pressure > 100 mmHg were considered eligible for sacubitril-valsartan at discharge. Ejection fraction was evaluated for all patients without an echocardiography confirming EF ≤35% in the previous 3 months.</p> <p>RESULTS: In the study period, 172 patients were admitted for decompensate heart failure, 36 (21%) with reduced ejection fraction, 27 (75%) male, mean age 79±9 years. 13 patients fulfilled all enrolment criteria for sacubitril-valsartan eligibility. This corresponds to 28% of the overall heart failure population with ejection fraction ≤ 35%. The eligible patients were younger (78±10 vs. 80±9 years), were less frequently men (69% vs 78%), had higher systolic blood pressure (127±13 vs. 119±22 mmHg), had a significantly higher eGFR (64,2±18,0 vs 52,6±28,1 ml/min/m2), had more atrial fibrillation (46,2% vs. 30,4%) and more COPD (38,5% vs 17,4%), were less frequently diabetic (46,2% vs. 47,8%%), had less ischemic heart disease (38,5% vs 56,5%) and less hypertension (69,2% vs 78,3) and had lower NT-proBNP (8574±6636 vs 12571±19863 pg/mL). Heart failure therapy was better optimized among eligible patients at admission: ACE inhibitor/ARB (100% vs 52,2%), Betablockers (100% vs 65,2%), MRA (46,2% vs 30,4%) and ivabradine (7,7% vs 4,3%).</p> <p>CONCLUSIONS: Only 28% of our real-world heart failure and reduced ejection fraction population was eligible for sacubitril-valsartan. The eligible patient is expected to be a younger man, with higher blood pressure, better renal function, less ischemic heart disease, better optimized heart failure drug therapy and lower NTproBNP levels at admission. The proportion of eligible patients rises to 50% if background medication is ignored.</p>
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