Sacubitril/valsartan in everyday clinical practice: an observational study based on the experience of a heart failure clinic

Cabral, Joana; Vasconcelos, Henrique; Maia-Araújo, Paulo; Moreira, Emília; Campelo, Manuel; Amorim, Sandra; Sousa, Ana; Moura, Brenda; Pinto, Roberto Damian Pacheco; Dias, Camila Teixeira de Carvalho; Silva-Cardoso, José

doi:10.21037/cdt-21-312

Cited by 6 publications

(5 citation statements)

References 25 publications

(34 reference statements)

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“…After 3 months of treatment, we found that the overall e cacy of the observation group was high and the NYHA grade was signi cantly improved, suggesting that SV can improve the clinical symptoms of MHD patients with HFpEF and is crucial for the improvement of their quality of life. A portuguese outpatient follow-up of patients with HF found that the duration of treatment after 41 months of SV showed a positive association with improvement in LVEF during follow-up, with a signi cant improvement in NYHA grade from baseline to the end of follow-up [17] , All of these ndings suggest that this drug can promote the improvement of NYHA grade in patients with HF, and the results of this study are consistent with the above.…”

Section: Discusssupporting

confidence: 88%

Clinical efficacy of sacubitril/valsartan in maintenance hemodialysis patients with HFpEF

Zhao

Zhang

et al. 2023

Preprint

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Background: Heart failure (HF) is a common comorbidity in maintenance hemodialysis (MHD) patients, of which ejection fraction preserved heart failure (HFpEF) is the main cause, resulting in substantial mortality and morbidity. However, there are still no effective therapeutic agents available for HFpEF. Sacubitril/valsartan (SV) has been shown to significantly improve clinical symptoms and reverse ventricular remodeling in patients with reduced ejection fraction of heart failure (HFrEF). The effect of SV in MHD patients with HFpEF remains unclear. Our study aimed to evaluate the efficacy and safety of SV in MHD patients with HFpEF. Methods: A total of 90 MHD patients with HFpEF admitted to the Department of Nephrology of Hefei Second People's Hospital from January 2021 to January 2022 were collected, and they were divided into control group and observation group according to random number method. Both groups received consistent basic treatment based on the results of the test, and at this baseline, one group received ACEI/ARB drugs as the control group, and the other group received SV as the observation group. The starting dose of SV was 50mg bid, and the dose was gradually increased according to blood pressure and blood potassium level until the target dose of 100mg bid was reached for 3 months.After 3 months of treatment, relevant indicators before and after treatment, such as NYHA grade, echocardiography related indicators, NT-proBNP, 6 minute walking distance (6 MWD), blood pressure level, serum potassium and incidence of adverse reactions, were collected and compared. Results: 1. A total of 90 patients with MHD and HFpEF, no patients stopped during the follow-up. There were no significant differences in general clinical data (age, number of months of dialysis, sex, primary disease), NYHA grade, serum NT-proBNP, serum potassium, blood creatinine, hemoglobin, LVEF, 6 MWD, SBP and DBP between the two groups (all P> 0.05).2. After 3 months of treatment, in terms of treatment effect, 41 people were significantly effective, 35 were effective and 14 were ineffective. The efficacy of the observation group was significantly higher than that of the control group, and the difference was statistically significant (P <0.05).3. After 3 months of treatment, LVEF in both groups increased significantly, LVEDD, LVESD, LVEDV, E/e' and PAP decreased compared with the previous group, and the difference before and after treatment in the observation group was more significant than that in the control group, and the difference before and after treatment in both groups was statistically significant (all P<0.05). The LVESV also decreased in both groups, and the difference between the observation group before and after treatment was statistically significant (P<0.05), while the difference between the control group was not statistically significant (P>0.05). 4.After 3 months of treatment, the 6MWD of patients in both groups increased compared with the previous group, and the NT-proBNP decreased compared with the previous group, and the difference before and after treatment in the observation group was higher than that in the control group, and the difference before and after treatment in both groups was statistically significant (both P<0.05). 5. After 3 months of treatment, the average SBP and DBP of the two groups decreased significantly compared with the previous group, and the difference before and after treatment in the observation group was significantly higher than that in the control group, and the difference before and after treatment between the two groups was statistically significant (both P<0.05); There was no significant change in serum potassium levels before and after treatment, and there was no significant difference (all P>0.05). 6. During the treatment follow-up process, the incidence of adverse reactions in the observation group was lower than that in the control group, and the difference was statistically significant (P <0.05). Conclusion: Our study shows that SV is effective and safe in the treatment of MHD patients with HFpEF.

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Section: Discusssupporting

confidence: 88%

Clinical efficacy of sacubitril/valsartan in maintenance hemodialysis patients with HFpEF

Zhao

Zhang

et al. 2023

Preprint

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“…Participants in this cross-sectional study were randomly recruited from the appointment lists of an outpatients HF and transplantation clinic of a Portuguese university hospital. Due to a lack of information regarding the number of attendees to the HF appointments for the period the data was collected (September 2017 to July 2018), we estimated the number of potentially eligible patients at 537, based on a study conducted in the same setting in a similar period [14]. Inclusion and exclusion criteria were applied at recruitment.…”

Section: Methodsmentioning

confidence: 99%

Statins are associated with reduced likelihood of sarcopenia in a sample of heart failure outpatients: a cross-sectional study

Valdiviesso

Sousa‐Santos

Azevedo

et al. 2022

BMC Cardiovasc Disord

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Background Sarcopenia is prevalent in heart failure (HF) patients, contributing to its poor prognosis. Statin use is postulated as a probable risk for developing sarcopenia, but little is known regarding this association in HF patients. This work aims at classifying and characterising sarcopenia and at describing the association of statin use with sarcopenia in a sample of Portuguese HF outpatients. Methods In this cross-sectional study, a sample of 136 HF patients (median age: 59 years, 33.8% women) was recruited from an HF outpatients’ clinic of a University Hospital in Portugal. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People 2. Clinical, nutritional, and dietary data were collected. Results A total of 25 (18.4%) individuals were categorised as sarcopenic, ranging from 12.2% in younger (< 65 years) participants vs. 30.4% in older ones and from 3.3% in men vs. 47.8% in women. Severe sarcopenia accounted for 7.4% of the sample and sarcopenic obesity was identified in 5.1% of the individuals. A total of 65.4% of the participants were statin users. In multivariable analysis (n = 132, 25 sarcopenic), the use of statins was inversely associated with sarcopenia (OR = 0.03; 95% CI = 0.01, 0.30). Each additional age year was associated with a 9% increase in the likelihood of being sarcopenic (OR = 1.09; 95% CI = 1.01, 1.17), and each Kg.m−2 increment in body mass index was associated with a 21% decrease in the likelihood of sarcopenia (OR = 0.79; 95% CI = 0.65, 0.96). The daily use of five or more medicines was also directly associated with sarcopenia (OR = 26.87; 95% CI = 2.01, 359.26). On the other hand, being a man and being physically active were inversely associated with sarcopenia (OR = 0.01; 95% CI = 0.00, 0.07 and OR = 0.09; 95% CI = 0.01, 0.65, respectively). Conclusions Contrary to what was expected, patients medicated with statins were less likely to be sarcopenic. Although this finding deserves further research, we hypothesise that this might be related to the pleiotropic effects of statins on endothelial function, contributing to better neuromuscular fitness.

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“…The data that supports this cross-sectional study were collected between September 2017 and July 2018 in a HF outpatients’ clinic of a northern Portuguese university hospital, regarding a population of 537 potentially eligible participants, estimated from a study developed in a similar period on the same setting [ 18 ]. Participants were randomly selected from the daily physicians’ appointments lists.…”

Section: Methodsmentioning

confidence: 99%

Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study

Valdiviesso,

Amaral,

Moreira

et al. 2023

BMC Cardiovasc Disord

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Background Frailty and sarcopenia have been extensively studied in heart failure (HF) patients, but their coexistence is unknown. The aim of this work is to describe the coexistence of these conditions in a sample of HF outpatients and its association with the use of medication and left-ventricular ejection fraction. Methods Participants in this cross-sectional study were recruited from a HF outpatients’ clinic in northern Portugal. Frailty phenotype was assessed according to Fried et al. Sarcopenia was evaluated according to the revised consensus of the European Working Group on Sarcopenia in Older People. Results A total of 136 HF outpatients (33.8% women, median age 59 years) integrated this study. Frailty and sarcopenia accounted for 15.4% and 18.4% of the sample, respectively. Coexistence of frailty and sarcopenia was found in 8.1% of the participants, while 17.6% had only one of the conditions. In multivariable analysis (n = 132), increasing age (OR = 1.13;95%CI = 1.06,1.20), being a woman (OR = 65.65;95%CI = 13.50, 319.15), having heart failure with preserved ejection fraction (HFpEF) (OR = 5.61; 95%CI = 1.22, 25.76), and using antidepressants (OR = 11.05; 95%CI = 2.50, 48.82), anticoagulants (OR = 6.11; 95%CI = 1.69, 22.07), furosemide (OR = 3.95; 95%CI = 1.07, 14.55), and acetylsalicylic acid (OR = 5.01; 95%CI = 1.10, 22.90) were associated with increased likelihood of having coexistence of frailty and sarcopenia, while using statins showed the inverse effect (OR = 0.06; 95%CI = 0.01, 0.30). Conclusions The relatively low frequency of coexistence of frailty and sarcopenia signifies that each of these two conditions still deserve individual attention from health professionals in their clinical practice and should be screened separately. Being a woman, older age, having HFpEF, using anticoagulants, antidepressants, loop diuretics and acetylsalicylic acid, and not using statins, were associated with having concomitant frailty and sarcopenia. These patients can potentially benefit from interventions that impact their quality of life such as nutritional and mental health interventions and exercise training.

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Sacubitril/valsartan in everyday clinical practice: an observational study based on the experience of a heart failure clinic

Cited by 6 publications

References 25 publications

Clinical efficacy of sacubitril/valsartan in maintenance hemodialysis patients with HFpEF

Clinical efficacy of sacubitril/valsartan in maintenance hemodialysis patients with HFpEF

Statins are associated with reduced likelihood of sarcopenia in a sample of heart failure outpatients: a cross-sectional study

Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study

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