Sacubitrilo-valsartán: 5 años de experiencia clínica en pacientes ambulatorios con insuficiencia cardiaca

Abstract

Introduction and objectivesSacubitril/valsartan (SV) has been shown to reduce cardiovascular mortality and readmissions in patients with heart failure and reduced ejection fraction (HFrEF). Our goal is to analyze in a real-life outpatient cohort of patients with HFrEF the effect of replacing angiotensin-converting-enzyme inhibitors with SV. MethodsRetrospective registry that included outpatients treated with SV in a third-level center. ResultsBetween 2016 and 2020, 419 patients with a median follow-up of 34 months were included; 16% (95%CI, 12.49-19.51) discontinued the drug. Mortality was 7.17 per 100 patients/year; 15% (95%CI, 11.58-18.42) had a heart failure hospitalization; 28.2% (95%CI, 23.89-32.51) improved ejection fraction, being a group with lower cardiovascular mortality and heart failure hospitalization (P<.001); 63.3% abandoned the previous indication of devices in primary prevention after initiation of SV. The predictors of improvement were the non-ischemic etiology (OR=0,35; 95%CI, 0.22-0.55; P<001) and the shortest evolution of the disease (OR=4.17; 95%CI, 2.35-7.38; P<.001). Patients with long-term HFrEF also showed improvement in left ventricular ejection fraction. ConclusionsReplacing angiotensin-converting-enzyme inhibitors with SV in patients with HFrEF had a significative impact in left ventricular ejection fraction, which implies an improvement in cardiovascular mortality and morbidity, a benefit that also exists in patients with a longer chronology of the disease. This improvement also associated a reduction in the indication of devices, especially in non-ischemic patients.