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Influence of Sacubitril-valsartan on outcomes of patients with chronic heart failure in different populations: Brazil and Portugal experience
Session:
Painel 2 - Insuficiencia Cardiaca 6
Speaker:
Fernanda Costa Ferreira
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Fernanda Costa Ferreira; Ricardo Mourilhe Rocha; Marta Afonso Nogueira; Carla Matias; Pedro Pimenta de Mello Spineti; Marcelo Imbroinise Bittencourt; Felipe Neves de Albuquerque; Ana Luiza Ferreira Sales; Denilson Campos de Albuquerque; Elia Baptista; Ines Nabais; Gonçalo Miranda Proença
Abstract
<p>Background:Sacubitril/Valsartan (Sac/Val) significantly reduces hospitalizations and mortality of heart failure patients (pts) with reduced ejection fraction (HFrEF). Considering that real world evidence is still scarce, it’s important to observe if there are regional differences regarding safety and efficacy. Objectives: To observe the effect of SacVal on clinical, therapeutic, hemodynamic and laboratorial parameters of two different outpatients’ populations with HFrEF followed-up in Brazil and Portugal. Methods: From August 2017 to January 2019, an observational study of two HFrEF cohorts, 74 portuguese and 47 brazilian patients with optimal drug therapy were switched from Angiotensin-Converting Enzyme Inhibitor/Angiotensin Receptor Blocker (ACEI-ARB) to Sac/Val. We observed the efficacy and safety of Sac/Val reggarding the differences in both groups according to demographics, laboratorial, echocardiogram and outcomes. Results: Comparing Brazil x Portugal: median follow-up was 182 [139-293] x 255 [124-337] days, age=62[55-74] x 74[64-80] years (p=0.001), 61.7% x 79.2% male (p=0.037), 34.8% x 61.4% with ischemic HF (p=0.008), 52.3% x 70.4% hypertension (p=0.049), 20.5% x 43.7% permanent atrial fibrillation (p=0.015). The median systolic blood pressure (SBP) pre Sac/Val was 105 [96-118] x 130 [113-141] (p<0.001), SBP post Sac/Val was 97 [87-113] x 125 [111-140] (p<0.001), dyastolic BP post Sac/Val was 65 [58-85] x 70 [65-80] (p=0.019). All other clinical parameters were similar. Considering ESC guidelines for HF therapy, 93.6% x 95.7% were using betablockers (p=0.161), 91.5% x 94.2% ACEI/ARB (p=0.571), 81.8% x 58.8% MRA (p=0.013), 90.9% x 73.9% loop diuretics (p=0.016) and 25% x 15.9% ivabradine (p=0.236), 0% x 15.7% CRT (p=0.006) and 4.5% x 20% ICD (p=0.026). The median SacVal dose was 200 [100-400] x 200 [100-200] (p=0.009). Regarding the laboratory parameters there were no differences. When data BEFORE and AFTER Sac/Val are compared, Brazil x Portugal, respectively: LVEF=28% [25-32] and 33.5% [24.4-39.9] in Brazil, 30% [25-35] and 35.6% [30.3-40.8] in Portugal (p=NS); median NTproBNP did not have any statistical difference. On ECG, the QRS had 120 [80-152] ms x 129 [110-166] (p=0.006). The NYHA functional classes improved post SacVal in both countries (p=NS). A significant therapeutic finding was a marked reduction in furosemide dose in both countries post SacVal (Brazil=58.5% x 40.4%, Portugal, p=0,101). During follow-up, there were no differences regarding hospitalizations and deaths either in Brazil or Portugal. About safety, Sac/Val had been discontinued in 8.7% in Brazil and 5.4% in Portugal (p=0.482). Conclusion: Although there were many differences between Brazil and Portugal populations, the efficacy and safety are similar which showed the great importance of using this new drug in all patients with HFrEF with indication to improve survival and outcomes.</p>
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