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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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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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Prescription of sacubitril/valsartan in a real-world population
Session:
Posters 4 - Écran 9 - Insuficiência Cardíaca
Speaker:
Tiago Graça Rodrigues
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:
Tiago Graça Rodrigues; João Pedro Ribeiro Agostinho; Rafael Santos; Nelson P. Cunha; Joana Rigueira; Afonso Nunes Ferreira; Miguel Almeida Ribeiro; Nuno Lousada; Fátima Veiga; Maria Mónica Mendes Pedro; Fausto José Pinto; Dulce Brito
Abstract
<p><strong>Introduction</strong>: The introduction of sacubitril/valsartan (S/V) in the therapeutic armamentarium for patients (pts) with chronic heart failure (HF) and a reduced ejection fraction (rEF) was the major pharmacological therapeutic advance in recent years. Given the short time since the introduction of S/V into clinical practice, there is not much comparative data between the real world populations and the PARADIGM-HF study population.</p> <p><strong>Objective</strong>: To characterize a population followed in the HF Clinic of a tertiary hospital medicated with S/V, and to compare it with the PARADIGM-HF Trial population.</p> <p><strong>Methods</strong>: Prospective data recording study of pts with HFrEF treated with S/V. Clinical and demographic characteristics, S/V doses, adverse effects and concomitant therapy data were evaluated. Comparisons with the PARADIGM-HF S/V treated population were established by Student's T-test and ANOVA.</p> <p><strong>Results</strong>: One hundred and two pts were included. Median follow-up time since S/V first dose-first patient was 6 (4-10) months. The study population presents statistically higher mean age, NTproBNP plasma levels and serum creatinine levels (sCr) when compared to the PARADIGM-HF population. There was a higher number of pts in NYHA functional class I and II, and ischemic etiology was less frequent. There were no significant differences regarding gender, systolic blood pressure or baseline ejection fraction (Table 1).</p> <p>This real-world population had a higher rate of ß-blocker and mineralocorticoid receptor antagonist prescription (Table 1); 59 pts (57.8%) started on S/V at the dose of 24+26mg and 43 pts (42.2%) at the intermediate dose. The average maximum tolerated dose was significantly lower than that reported in PARADIGM-HF (175±84 vs 375±71 mg/day, P<0.001): low dose in 28 pts (27.5%), intermediate dose in 54 pts (52.9%) and high dose in 20 pts (19.6%). The mean dose of ACEi/ARB before S/V initiation was lower than that reported in PARADIGM-HF (dose equivalent to enalapril 14.75±11.75 mg/day vs. 18.9±3.4, P =0.01), and 4 pts (3.9%) were medicated with ACEi/ARB previously. The rate of ICD and/or CRT implantations was much higher in the real-world population (table 1).</p> <p>S/V was discontinued in 7 pts (6.9 vs. 2.3%, P= NS): in 4 pts due to symptomatic hypotension (3.9 vs. 0.9%, P=0.011), in 1 due to cough (1 vs. 0%, P =NS), in 1 due to angioedema (1 vs. 0.4%, p =0.003), and in 1 due to HF decompensation (1 vs. 0%, P =NS).</p> <p>The mortality rate in this study population was 3.9% (4 pts).</p> <p><strong>Conclusions</strong>: When comparing the PARADIGM-HF Trial population with a real-world population, it was observed that the latter includes older patients with higher levels of NTproBNP and sCr, and that maximal S/V tolerated doses were lower than those reported in the PARADIGM-HF trial. The rate S/V discontinuation due to adverse events was similar, attesting the safety of the drug in daily practice.</p>
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