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Sacubitril-valsartan: the earlier, the better?
Session:
Posters (Sessão 3 - Écran 4) - Insuficiência Cardíaca 3 - Terapêutica Farmacológica
Speaker:
Ana Filipa Abreu Cardoso
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:
Ana Filipa Cardoso; Mariana Tinoco; Geraldo Dias; Bebiana Faria; Tamara Pereira; Marina Fernandes; Filipa Almeida; António Lourenço
Abstract
<p><strong>Introduction:</strong> Sacubitril/valsartan (S/V) is recommended in ambulatory patients (pts) with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal treatment. Our aim was to study the impact of timing of initiation of S/V on cardiovascular (CV) outcomes of a HFrEF population.</p> <p><strong>Methods:</strong> Single centre retrospective study that included all HFrEF pts followed at the HF Clinic of the Cardiology Department with at least 1 year of follow-up. Pts diagnosed ≥4 years and those not treated with S/V were excluded. Pts were divided into 2 groups: group 1 (G1) if S/V was initiated in the first 6 months from HFrEF diagnosis and group 2 (G2) if S/V initiation occurred more than 6 months from diagnosis.</p> <p>The primary endpoint was a composite of admission for decompensated HF and CV death during the follow-up.</p> <p><strong>Results: </strong>Of a total of 158 pts, 59 were included (81% males; mean age 63±13 years). Dilated cardiomyopathy (35;59%) and ischemic cardiomyopathy (24;41%) were the most frequent aetiologies.</p> <p>Median time from diagnosis to first HF Clinic visit was 2 (IQR 1-12) months. The majority of pts was on NYHA II functional class (36; 61%) and 41 (69%) had a previous HF admission. Nine (15%) pts were angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers naïve.</p> <p>Twenty-two (37%) pts initiated S/V in the first 6 months from HFrEF diagnosis (G1). Their comorbidity profile and baseline echocardiographic parameters were similar to G2 pts.</p> <p>Median time from HFrEF diagnosis to S/V initiation was 1 month (IQR 0-6) in G1 and 32 months (IQR 17-57) in G2.</p> <p>Both groups had achieved similar median target doses of S/V (p=.574), beta-blocker (p=.123) and mineralocorticoid therapy (p= .159). Median doses of diuretic were lower in G1 (0mg IQR 0-25 vs 40mg IQR 0-80, p=.008).</p> <p>A revaluation echocardiogram after optimal medical therapy showed a significative higher increase in left ventricle ejection fraction (LVEF) on G1 compared to G2 (25±1% to 41±3% vs 27±1% to 33±2%, p=.039).</p> <p>During a median follow-up of 23months (IQR 9-30) there were 5 hospitalizations for HF, 3 CV deaths and 1 non-CV death. Pts in G1 had a significantly lower incidence of the primary endpoint (0 vs 16 events per 100 person-year; log-rank p=.010).</p> <p><strong>Conclusion:</strong> Pts who started S/V in the first 6 months from HFrEF diagnosis had a higher increase in LVEF, less HF hospitalizations and CV deaths. These findings suggest a better overall prognosis in earlier initiation of S/V after HFrEF diagnosis.</p>
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