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Predictors of Sacubitril-Valsartan target dose achievement in a real-world population
Session:
Posters (Sessão 3 - Écran 4) - Insuficiência Cardíaca 3 - Terapêutica Farmacológica
Speaker:
MARIANA GOMES TINOCO
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana Tinoco; Ana Filipa Cardoso; Geraldo Dias; Tamara Pereira; Bebiana Faria; Filipa Almeida; Sérgio Leite; António Lourenço
Abstract
<p><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Introduction</span></span></span></strong></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">PARADIGM-HF demonstrated superiority of Sacubitril-Valsartan (SV) over enalapril in patients with heart failure with reduced ejection fraction (HFrEF). However, achievement of target doses (TD) used on clinical trials can be difficult in real world practice. </span></span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Purpose</span></span></span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">This study assesses the ability to achieve TD and its predictors in a real-world population.</span></span></span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">Methods</span></span></span></span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Retrospective study of patients with </span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">HFrEF under SV therapy</span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black"> observed at an HF clinic between Jan 2018 and Jun 2020, with a follow up period until Oct 2021. </span></span></span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><strong><span style="color:black">Results</span></strong></span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">A total of 90 patients were included: 80% (72) male, 65±12 years, mostly with dilated cardiomyopathy (46,7%, 42) and ischemic cardiomyopathy (42,2%; 38). </span></span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">On the evaluation before starting SV, mean LVEF was 26,35±7,32%, 50% were in class III-IV; 89% were on ACEI/ARB, 92% on beta-blocker and 92% on MRA; 43,3% had an ICD and 31,1% a CRT-D; </span></span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">Up-titration to TD was achieved in<span style="background-color:white"> 52 (57,8%) patients. </span></span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">A higher systolic blood pressure</span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black"> (p=0,008), higher eGFR (p=0,049), lower NT-PBNP (p=0,025), higher body mass index (BMI) (p=0,026) and a higher previous dose of ACEI/ARB (p=0,013) were associated with achieving TD. On multivariate analyses, BMI was found to be the only independent predictor of </span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">achieving TD </span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">(p=0,031). </span></span></span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="background-color:white"><span style="color:black">Symptomatic hypotension (66%; 25) was the main impediment to attaining TD, followed by renal deterioration (24%; 9), hyperkalaemia (5%; 2) and itch (5%; 2).</span></span><span style="color:black"> Dose reduction was needed in 12,2% (11), being symptomatic hypotension (8, 73%) and hyperkalaemia (3, 27%) the most common reasons.</span> <span style="color:black">SV discontinuation occurred</span><span style="background-color:white"><span style="color:black"> in 7 (7,8%) patients due to </span></span><span style="color:black">symptomatic hypotension (43%; 3), economic insufficiency (29%; 2), worsening renal function (14%; 1) and itch (14%; 1). </span></span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">Patient assigned to TD, were more often able to reduce dose (p=0.022) and suspend (p=0,002) furosemide and more often had an increase in serum creatinine (1,08 vs 1,37 mg/dl; p=0,014), without leading to hospitalizations or higher risk for hyperkalaemia. </span></span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">Achieve TD was associated with lower major adverse CV events (p=0,037), lower deaths for CV causes (p=0,026), lower hospitalizations for HF (p=0,033) and lower need of inotropic support (p=0,047)</span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">Conclusions</span></span></span></span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">Achievement of TD was possible in the majority of the cohort being BMI its strongest predictor. Reduction in diuretic use and dose was possible in a large percentage of the population. </span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Achieve TD had a greater impact on HFrEF prognosis.</span></span></span></span></span></p>
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