Outcomes of Angiotensin Receptor-Neprilysin Inhibitor Prescriptions for Patients with Heart Failure and Reduced Ejection Fraction in Real World Clinical Practice

2018 ◽  
Vol 24 (8) ◽  
pp. S28
Author(s):  
Rhynn J. Malloy ◽  
Katelyn V. Smith ◽  
Gretchen M. Stern ◽  
Akshay S. Desai
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Ejection Fraction ◽  
Real World ◽  
Angiotensin Receptor ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
Patients With Heart Failure ◽  
Angiotensin Receptor Neprilysin Inhibitor

scholarly journals Effect of Angiotensin Receptor-Neprilysin Inhibitor and Sodium-Glucose Co-transporter-2 Inhibitor Combination Therapy in Diabetic Patients with Heart Failure with Reduced Ejection Fraction: A Retrospective Study

2021 ◽  
Author(s):  
Hyue Mee Kim ◽  
In-Chang Hwang ◽  
Wonsuk Choi ◽  
Yeonyee E. Yoon ◽  
Goo-Yeong Cho
Keyword(s):  
Heart Failure ◽  
Combination Therapy ◽  
Ejection Fraction ◽  
Diabetic Patients ◽  
Angiotensin Receptor ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
Patients With Heart Failure ◽  
Angiotensin Receptor Neprilysin Inhibitor ◽  
Group 1

Abstract Background Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose co-transporter-2 inhibitor (SGLT2i) have shown robust benefits in improving cardiac function and disease prognosis in diabetic patients with heart failure with reduced ejection fraction (HFrEF). However, their combined effect has not been revealed. Methods We retrospectively identified diabetic patients with HFrEF who were prescribed an ARNI and/or SGLT2i. Diabetic patients with HFrEF treated with standard HF therapy but not ARNI or SGLT2i were included as controls. The patients were divided into groups treated with both ARNI and SGLT2i (group 1), ARNI but not SGLT2i (group 2), SGLT2i but not ARNI (group 3), and neither ARNI nor SGLT2i (group 4). After propensity score-matching, the occurrence of hospitalization for heart failure (HHF), cardiovascular mortality, and changes in echocardiographic parameters were analyzed. Results Of the 206 matched patients included in the study, 90 (43.7%) had to undergo HHF and 43 (20.9%) died of cardiovascular causes during a median 25 months of follow-up. Patients in group 1 exhibited a lower risk of HHF and cardiovascular mortality compared to those in the other groups. Improvements in the left ventricular ejection fraction and mitral E/e’ were more pronounced in group 1 than in groups 2, 3 and 4. These echocardiographic improvements were more prominent after the initiation of ARNI, compare to the initiation of SGLT2i. Conclusion In diabetic patients with HFrEF, combination of ARNI and SGT2i showed significant improvement in cardiac function and prognosis. ARNI-SGLT2i combination therapy may improve the clinical course of HFrEF in diabetic patients.

scholarly journals Key Considerations For Integrating Sacubitril/Valsartan Into Chronic Heart Failure Management

2018 ◽  
Vol 2 (2) ◽  
pp. 34-43
Author(s):  
Matthew P. Lillyblad
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Drug Administration ◽  
Angiotensin Receptor ◽  
Heart Failure Management ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
Angiotensin Receptor Neprilysin Inhibitor

Heart failure with reduced ejection fraction remains a prevalent clinical syndrome associated with significant morbidity and mortality. Despite significant advances in heart failure with reduced ejection fraction pharmacotherapy, 5-year mortality remains 50%. Sacubitril/valsartan is a first-in-class angiotensin-receptor-neprilysin inhibitor, Food and Drug Administration–approved to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure with reduced ejection fraction. Sacubitril/valsartan is recognized as a significant therapeutic advancement and endorsed by national guidelines, yet adoption into clinical practice has lagged across the United States. Recommendations for use differ greatly between the Prospective Comparison of Angiotensin-Receptor-Neprilysin Inhibitor with Angiotensin-Converting-Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure clinical trial, international guidelines, and the Food and Drug Administration-approved labeling, which can lead to uncertainty with prescribing. It is essential to establish an evidence-based, pragmatic approach to patient selection and management of sacubitril-valsartan facilitate integration into clinical practice. This review summarizes the pharmacology of sacubitril/valsartan, its known benefits and risks, and important considerations for incorporating sacubitril/valsartan into chronic heart failure management.

Angiotensin Receptor Neprilysin Inhibitor for Patients With Heart Failure and Reduced Ejection Fraction: Real-World Experience From Taiwan

2019 ◽  
Vol 25 (2) ◽  
pp. 152-157 ◽  
Author(s):  
Fu-Chih Hsiao ◽  
Chun-Li Wang ◽  
Po-Cheng Chang ◽  
Yu-Ying Lu ◽  
Chien-Ying Huang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Real World ◽  
Index Date ◽  
Left Ventricular ◽  
Angiotensin Receptor ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
Angiotensin Receptor Neprilysin Inhibitor

Background: Angiotensin receptor neprilysin inhibitor (ARNI) was recommended by major guidelines as the frontline therapy for heart failure with reduced ejection fraction (HFrEF) since its clinical benefit was proved in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF) trial. However, little is known about its safety and effectiveness in real-world practice, often with sicker and more fragile patients. In addition, East Asia population is underrepresented in PARADIGM-HF trial. Methods: We performed a retrospective analysis of patients who received ARNI in 3 medical institutes located in Northern Taiwan. Patients who received a prescription of at least 30 days of ARNI were enrolled. The date of first prescription was defined as the index date, and a period of 12 months preceding the index date was defined as the baseline period. Results: A total of 452 patients were identified (age: 61.9 ± 15.0, male: 79.4%). Compared to PARADIGM-HF populations, our patients had higher values of baseline serum creatinine (mean: 1.5 vs 1.1 mg/dL) and B-type natriuretic peptide (BNP; median: 554.5 vs 255 pg/mL). After 12 months, 41.6% of the patients received less than half of the standard dose. Overall, all-cause death, cardiovascular death, and heart failure readmission rate were 3.0%, 1.1%, and 6.9% in 12 months, respectively. In those who had both baseline and 12-month data, renal function did not change (1.7-1.8 mg/dL, P = .091), left ventricular ejection fraction improved (30.8%-36.8%, P < .001), BNP decreased (777.0-655.8 pg/mL, P = .032), and uric acid decreased (7.5-7.1 mg/dL, P = .009). Conclusion: In our study, patients with HFrEF had higher BNP and serum creatinine level at baseline and had received lower dose of ARNI than the PARADIGM-HF populations. Angiotensin receptor neprilysin inhibitor appeared to be safe as regard renal function and effective in real-world practice. Left ventricular reverse remodeling was observed 1 year after heart failure medication treatment, including ARNI.

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