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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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C. Arrhythmias and Device Therapy
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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
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12. Coronary Artery Disease (Chronic)
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15. Valvular Heart Disease
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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
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34. Public Health and Health Economics
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ARNI use in clinical practice: PARADIGM-HF trial results applied to the real world
Session:
Posters 4 - Écran 9 - Insuficiência Cardíaca
Speaker:
João Agostinho
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 Pedro Ribeiro Agostinho; Tiago Graça Rodrigues; Rafael Santos; Nelson P. Cunha; Afonso Nunes Ferreira; Joana Rigueira; Inês Aguiar Ricardo; Fátima Veiga; Miguel Almeida Ribeiro; Nuno Lousada; Fausto José Pinto; Dulce Brito
Abstract
<p><strong>Introduction</strong>: The PARADIGM-HF trial showed the clinical benefits of the addition of sacubitril to the conventional neurohormonal antagonist therapy regimen for heart failure (HF) with reduced ejection fraction (rEF). However, national data on the effects of sacubitril/valsartan (S/V) introduction in real-life patients (pts) is scarce.</p> <p><strong>Objective</strong>: To evaluate the clinical effects of S/V introduction in a population of pts with HFrEF followed in a tertiary hospital HF Clinic.</p> <p><strong>Methods</strong>: Prospective study of consecutive pts with HFrEF treated with S/V. Clinical, echocardiographic and laboratorial data were collected before and after the introduction of the drug. Episodes of HF decompensation (defined as the need to increase oral dose of diuretics or intravenous administration of diuretics) and hospitalizations during the follow-up period were registered. The number of decompensation episodes or hospitalization were compared with the number of similar events that occurred in a period with exactly the same time duration but preceding the first dose of S/V. Comparative statistical analysis was performed using Wilcoxon test.</p> <p><strong>Results</strong>: One hundred and two pts were included. The median follow-up time was 6 (4-10) months. There was a significant improvement in NYHA functional class (FC), mainly due to a marked decrease in the number of pts in CF III (15.7 vs. 2%, P <0.001) (Table 1). Mean left ventricle ejection fraction (29.5±3.2 vs. 34±5.8%, P =0.005) also improved, and NTproBNP was significantly reduced (3107±2128 vs. 2619±1437pg/mL, P <0.001) after S/V prescription.</p> <p>There was no significant change in serum creatinine (1.24±0.49 vs. 1.26±0.46 mg/dL, P =NS) or systolic blood pressure (120.2±18.8 vs. 119.2 ± 18.8mmHg, P =NS).</p> <p>Importantly, there was a significant reduction in the number of HF decompensations (49 episodes in 37 pts vs. 10 episodes in 8 pts, P <0.001) and hospitalizations (31 episodes in 23 pts vs. 10 events in 7 pts, P <0.001) after initiation of the drug.</p> <p><strong>Conclusion</strong>: Starting sacubitril/valsartan in a population of patients followed in a HF Clinic was associated with significant clinical improvement, marginal echocardiographic improvement, and NTproBNP reduction. In parallel, the introduction of the drug led to a significant reduction of HF decompensation episodes and hospitalizations. These data derived from a real-life population confirm the benefits of sacubitril/valsartan firstly demonstrated in the PARADIGM-HF Trial.</p>
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