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Vericiguat Eligibility in Heart Failure: Early Post-Discharge Assessment
Session:
Sessão de Posters 37 - Insuficiência cardíaca - Terapêutica farmacológica
Speaker:
Mariana Passos
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Passos; Filipa Gerardo; Carolina Mateus; Joana Lima Lopes; Inês Miranda; Mara Sarmento; Inês Fialho; Ana Oliveira Soares; David Roque
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Background:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> The </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">VerICiguaT Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial demonstrated that vericiguat reduces the composite endpoint risk of mortality and heart failure (HF) hospitalizations in patients with a recent worsening event on top of guideline-directed medical therapy (GDMT). In October 2023, vericiguat obtained reimbursement approval from the Portuguese medicine authority.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Objectives:</span></span></span></strong> <span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:#333333">To estimate the suitability for vericiguat based on VICTORIA trial eligibility in </span></span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">patients evaluated during an early post discharge appointment (EPDA) for HF.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif"> <span style="background-color:white"><span style="color:#333333">We applied the enrollment criteria of the VICTORIA trial to patients assessed in an HF EPDA at a single center between March 2021 and September 2023.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:#333333">Results:</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:#333333"> A total of 200 HF patients with EF < 45% attended an EPDA a median of 12 </span></span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">[IQR 10-14] <span style="background-color:white"><span style="color:#333333">days post-discharge. The inclusion criteria of VICTORIA trial were fulfilled only by 21,5% (n=43) of patients (m</span></span>ean age 66.1±15.1 years, 41.9% female). <span style="background-color:white"><span style="color:#333333">The main reason for exclusion was <em>de novo</em> HF (n=98; 49%), followed by systolic blood pressure (SBP) < 100mmHg (n=19; 17.2%).(Fig.1) Randomization based on SBP at discharge </span></span><span style="background-color:white"><span style="color:black">would lead to exclusion of additional 17 patients (37 vs 19 patients, p=0.005).</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">All included patients were on maximal tolerated GMDT, with 58% (n=25) on triple therapy, similar to the VICTORIA trial (60%), including </span></span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitor, beta-blocker, and mineralocorticoid receptor antagonist. However, in our sample, 90% (n=39) were also on <span style="background-color:white">sodium-glucose cotransporter type 2</span>. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Our population had a higher proportion of women (41.9 vs 23.9) and black (41.9 vs 4.9) patients, a lower mean EF (24 vs 30%), with 90% having an EF<40% (vs 85.7%) and a higher NTproBNP value at randomization (</span></span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">4421 vs 3377 pg/ml).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Within 90 days post-discharge, our population experienced a 37.2% HF hospitalization rate and 2.3% cardiovascular mortality.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif"> Only 4 in 20 patients meet the criteria of VICTORIA trial, a number that would be lower using discharge data. One However, 39.5% of patients eligible for vericiguat experienced an HF-related event, a rate that could be modified, given vericiguat potential to modify prognosis. A follow-up visit within 2 weeks after discharge allows for medication adherence assessment and GMDT titration, including novel drugs as vericiguat.</span></span></span></span></p>
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