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CPC 2019
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
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
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0 Themes
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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Real world immunomodulation: what results?
Session:
Posters 5 - Écran 6 - Insuficiência Cardíaca
Speaker:
Bebiana Faria
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:
Bebiana Faria; Filipa Canário Almeida; Margarida Oliveira; Pedro von Hafe; Geraldo Dias; Ana Filipa Cardoso; Sílvia Ribeiro; António Lourenço
Abstract
<p><strong>Introduction</strong>: Heart failure (HF) has an increasing prevalence with high morbility and mortality. Sacubitril/valsartan is the first of the class of Angiotensin Receptor-Neprilysin Inhibitors (ARNI) and was shown to be superior to enalapril in patients with reduced fraction ejection (FE) with a very significant reduction of cardiovascular events including mortality.</p> <p><strong>Purpose and Methods</strong>: The purpose of this study was assess if there are significant differences before and after the onset of the ARNI in the clinical set, by NYHA functional class, change in the pBNP value and change in the number of clinical events, defined as total number of arrivals to the emergency department and hospital admissions during the past year.</p> <p>A retrospective cohort study that included all patients observed, between 2 january and 5 December 2018, in advanced HF consultation (HFC) with indication for onset ARNI (LVEF ≤35% and NYHA functional class ≥2). Clinical and analytical data were collected and statistical analysis was performed with IBM SPSS 20.</p> <p><strong>Results</strong>: Of the total number of patients observed in the HFC, 69 fulfilled the criteria for therapy with ARNI. Of these patients, 78.3% were males with a mean age of 67±10 years. The average value of LVEF was 22±5%. The most frequent HF etiology was ischemic heart disease (49%) followed by dilated cardiomyopathy (45%). The majority of patients were, on the date of the last clinical evaluation, in class NYHA III (48%) and NYHA II (45%). Only 7% were in class NYHA IV.</p> <p>Thirty-five percent (n=24) of the total patients were treated with ARNI, 38% with the maximum dose (97/103mg) and 33% with the minimum dose (24/26mg), with a treatment mean time of 207 days. In the group of the patients with ARNI 67% reported a significant improvement in NYHA functional class (p = 0.003). The majority of patients who did not report improvement of functional class were in NYHA class II before ARNI onset.</p> <p>In relation to the analytical evaluation with pBNP, there was a significant difference between the pretreatment mean value (3385ng/mL) and posttreatment (1861ng/mL) (p=0.004), with an average reduction of 35% from baseline value of pBNP.</p> <p>We observed a total of 36 events. Of all the patients who presented events, 72% were not medicated with ARNI. There was no significant difference between the number of events between ARNI and non-ARNI patients, although, of all the patients with ARNI 45% presented events comparatively to a 58% in group of patients without ARNI. We also observed a significant reduction in the number of hospitalization days in patients with ARNI vs non-ARNI (11 vs 19 days) (p = 0.036).</p> <p><strong>Conclusion</strong>: Patients under ARNI showed a significant improvement in NYHA functional class and reduction of pBNP. We observed a significant reduction in the total number of hospitalization days in patients with ARNI, but no difference was observed in the number of events, possibly explained by treatment mean time of only 207 days.</p>
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