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Effectiveness and safety of sacubitril/valsartan in patients with chronic kidney disease – a real-world experience
Session:
Comunicações Orais - Sessão 18 - Insuficiência cardíaca: tratamento
Speaker:
Sara Couto Pereira
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sara Couto Pereira; Tiago Rodrigues; Afonso Nunes-Ferreira; João R. Agostinho; Fausto J. Pinto; Dulce Brito
Abstract
<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Background: </span></span></strong><span style="font-size:11pt"><span style="color:black">Sacubitril/valsartan is a cornerstone treatment in patients with heart failure and reduced ejection fraction (HFrEF). Data regarding the effectiveness and safety of sacubitril/valsartan in patients with chronic kidney disease (CKD) are scarce. We aimed to evaluate the effectiveness and safety of sacubitril/valsartan in patients with HFrEF and CKD in a real-world setting.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Methods: </span></span></strong><span style="font-size:11pt"><span style="color:black">We included<strong> </strong>consecutive ambulatory HFrEF patients followed in a HF clinic that initiated sacubitril/valsartan between February 2017 and October 2020, stratified by CKD (excluding those in stage 5/under dialysis). Demographic and clinical data, all-cause mortality and hospitalizations due to acute decompensated HF during the 12 months before sacubitril/valsartan initiation and during follow up were retrospectively evaluated. Primary outcomes were the incidence rate per 100 patient-years and the annualized length of stay (LOS) of acute decompensated HF hospitalizations (HHF). Secondary outcomes were all-cause mortality, NYHA class improvement and titration of sacubitril/valsartan.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Results:</span></span></strong><span style="font-size:11pt"><span style="color:black"> We included 179 patients, 77 with CKD at baseline (11 in stage 4). CKD patients were older (72±10 vs. 65±12 years, p<0.001), had higher NT-proBNP plasma values (4623±5266 vs. 1901±1835 pg/mL, p<0.001) and high incidence of anaemia (p<0.001), without other significant differences. Most of them were at NYHA functional class II (69% in CKD group vs. 79%, p=NS). During a mean follow up of 19±11 months, a significant and similar improvement in NYHA class (-0.53, 95%CI:[-0.67,</span></span> <span style="font-size:11pt"><span style="color:black">-0.38] in CKD patients vs. -0.55, 95%CI:[-0.67,-0.43], p=0.670) and a significant reduction in the rate of HHF was observed after sacubitril/valsartan initiation (67.7 to 28.8 hospitalizations per 100 patient-years in CKD group, adjusted rate ratio=0.425, 95% CI:[0.234, 0.773]; p=NS between the two groups, table 1). There was a significant reduction in annualized LOS of 5 days in both groups (p=0.319, table 1). CKD patients had a higher rate of all-cause mortality during follow up, without significant differences compared to non-CKD patients (HR=2.405, 95%CI:[0.841; 6.879], p=0.102). There were no significant differences between the two groups regarding maximum dose of sacubitril/valsartan achievement and withdrawal during follow up.</span></span></span></span></span></p> <h2 style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black"><strong>Conclusion:</strong> In this real-world population study in patients with HFrEF and CKD sacubitril/valsartan was effective on reducing hospitalization rates and length of stay without affecting all-cause mortality.</span></span></span></h2>
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