Real-world experience of angiotensin receptor/neprilysin inhibitor (ARNI) usage in Thailand: a single-center, retrospective analysis

BMC Cardiovascular Disorders

Thanyaluck Sotananusak¹  Pitchapa Kaewkan²  Teerapat Yingchoncharoen²  Wipharak Rattanavipanon³  Arisa Chandrsawang³  Surakit Nathisuwan³  Fairus Yamaae³ 

[1] Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand;Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand;Faculty of Pharmacy, Mahidol University, Bangkok, Thailand;

关键词: Heart failure;    Sacubitril;    Valsartan;    Angiotensin receptor;    Neprilysin inhibitor;   

DOI  :  10.1186/s12872-021-02145-9

来源: Springer

【 摘 要 】

BackgroundTreatment of heart failure with reduced ejection fraction (HFrEF) has been revolutionized by angiotensin receptor/neprilysin inhibitor (ARNI). ARNI has been shown to significantly reduce morbidity and mortality in a large, randomized controlled trial. However, real-world evaluation of ARNI with a diverse population is still limited.MethodsHFrEF patients receiving angiotensin receptor/neprilysin inhibitor (ARNI) or standard HF treatment at a university hospital in Thailand were prospectively followed-up from January 2015 to December 2019. The primary outcome was a composite of all-cause mortality and heart failure hospitalization. Survival analysis and the Cox proportional hazard model were used to compare clinical outcomes between the two groups.ResultsDuring a follow-up period of 12 months, the primary outcome occurred in 10 patients in the ARNI group (11.5%) and 28 in the standard treatment group (28.0%) (hazard ratio 0.34; 95% CI: 0.15–0.80; p = 0.013). After adjustment for confounding factors, ARNI was significantly associated with a significant reduction in the primary outcome (HR 0.32, 95% CI: 0.13–0.82, p = 0.017). In addition, ARNI was also significantly associated with a decrease in the clinical signs and symptoms of HF, including dyspnea, orthopnea, and fatigue. Orthostatic hypotension was more frequently reported among the ARNI group than among the standard treatment group. The rates of target dose achievement were comparable between the two groups.ConclusionIn real-world practice, ARNI use was associated with a significant reduction in both clinical outcomes and symptom improvement, while orthostatic hypotension was more common in patients in the ARNI group than in patients in the standard treatment group.

【 授权许可】

CC BY