SPC365

Pharmacologic transition in the care of patients with heart failure with reduced ejection fraction - a real life analysis

Session: Posters (Sessão 5 - Écran 2) - Insuficiência cardíaca - tratamento farmacológico
Speaker: Isabel Cruz

Congress: CPC 2023
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Isabel Cruz; Inês Campos; Bruno Bragança; Rafaela Lopes; Inês Oliveira; Joel Monteiro; Rui Pontes Dos Santos; Aurora Andrade

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>1. Introduction</strong></span></span><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Modulation of the renin-angiotensin-aldosterone and sympathetic nervous systems is crucial in the management of patients (pts) with heart failure with reduced ejection fraction (HFrEF). Additionally, the use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) has become an additional weapon to reduce the risk of cardiovascular (CV) death and worsening HF in this group of pts.</span></span></p>

<p style="text-align:justify"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">2. Purpose</span></span></strong><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Evaluate pts with HFrEF concerning the use of neurohormonal antagonist (NHA) therapy and SGLT2i therapy, to identify the effects of these drugs on major CV endpoints in a real-life setting. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>3. Methods</strong></span></span><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Unicentric, retrospective analysis of pts followed from 2011 to 2019 due to HFrEF (ejection fraction&lt;40%). Pts were evaluated regarding the prescription of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor-neprilysin inhibitor (ARNi), mineralocorticoid receptor antagonists (MRA), beta-blockers (BB) and SGLT2i. The endpoints were: composite of all-cause mortality and HFhosp; all-cause mortality; CV mortality; HFhosp. Pearson&acute;s Chi2 tests and binary logistic regressions were performed. </span></span></p>

<p style="text-align:justify"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>4. Results</strong></span></span><br />
<span style="font-family:Calibri,sans-serif; font-size:11pt">A total of 400 pts were included (72.8% male, mean age 60.5&plusmn;13.0 years). 69.3% pts were prescribed with ACEi/ARB, 16.5% pts with ARNi, 90.3% with BB, 53.3% with MRA and 6.5% with SGLT2i. During follow-up there was a mortality rate of 24.0% (61.5% due to CV causes) and a rate of HFhosp of 20.0%. The prescription of ARNi was related with fewer composite events (3.5% vs 30.8%, p=.015), CV mortality (0.3% vs 14.5%, p&lt;.001) and all-cause mortality (0.3% vs 23.8%, p&lt;.001). MRA (10.5% vs 13.5%, p=.032) and SGLT2i (0.3% vs 23.8%, p=.013) were associated with lower all-cause mortality.</span><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Binary logistic regression isolated use of ACEi/ARB and ARNi was the drugs associated with fewer outcomes. Specifically, ACEi/ARB and ARNi were associated with fewer composite events (p&lt;.001, OR 0.261, 95% CI 0.138-0.496 and p&lt;.001, OR 0.137, 95% CI 0.058-0.325, respectively); lower all-cause mortality (p&lt;.001, OR 0.243, 95% CI 0.129-0.460 and p&lt;.001, OR 0.013, 95% CI 0.002-0.104, respectively); CV mortality (p=.002, OR 0.331, 95% CI 0.165-0.662 and p=.001, OR 0.032, 95% CI 0.004-0.252, respectively); HFhops (p&lt;.001, OR 0.250, 95% CI 0.127-0.492 and p=.007, OR 0.303, 95% CI 0.127-0.723, respectively). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong>5. Conclusion</strong></span></span></span></span><br />
<span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black">This cohort illustrates the prognostic improvement of the transition into the most recent pharmacological classes of HF management. The prescription of ACEi/ARB and ARNi were associated with fewer CV events. Moreover, the logistic regression revealed that ARNi prescription presented a higher effect size than ACEi/ARB regarding CV mortality. This reinforces the great benefit of this drugs in reducing major CV events in pts with HFrEF. </span></span></span></span></p>