| Objective:By analyzing the application of sacubitril/valsartan in real-world heart failure patients in a single center,and evaluating its efficacy in the treatment of heart failure patients in the real world,summarizes the use of sacubitril/valsartan in real-world heart failure patients.Thus providing clinicians with valuable information for the use of sacubitril/valsartan.Methods:A retrospective analysis of the clinical data of patients with heart failure in the Affiliated Hospital of North Sichuan Medical College from March 7,2020 to June 31,2021.According to whether taking ARNI or ACEI/ARB,they were divided into ARNI group(taking ARNI),ACEI/ARB group(taking ACEI/ARB),and control group(neither ARNI nor ACEI/ARB was taken).The clinical data of heart failure patients during hospitalization were collected,including demographic information,vital signs,length of hospital stay,heart failure etiology,heart failure treatment drugs,NYHA,echocardiographic data,and laboratory data.The number of heart failure readmissions and the use of heart failure treatment drugs during the follow-up period of the patients were also recorded.Statistical analysis was performed using SPSS 25.0 software,and P<0.05 indicated a statistically significant difference.Results:1.A total of 1501 patients were included in this study,the mean age was(70.8±11.2)years,the mean systolic blood pressure was(129.7±22.1)mmHg,926(61.7%)were male,and the mean hospital stay was 10(7,13)days.The most common cause of hospitalized patients with heart failure was ischemic cardiomyopathy(38.5%).The utilization rates of sacubitril/valsartan,diuretics,ACEI/ARB,β-blockers,spironolone,digoxin,oral anticoagulants and antiplatelet drugs in inpatients with heart failure were 18.7%,71.6%,32.0%,63.7%,63.6%,29.8%,22.3%and 78.1%,respectively.The proportion of HFrEF,HFmrEF and HFpEF in hospitalized heart failure patients was 23.7%,19.1%and 57.2%,respectively.The classification of patients were 19.8%(NYHA Ⅰ),38.3%(NYHA Ⅱ),31.3%(NYHA Ⅲ),and 10.5%(NYHA Ⅴ),respectively.The baseline of NT-proBNP in hospitalized heart failure patients was 2496(1094,4989)pg/mL.2.Compared with the control group and the ACEI/ARB group,the patients in the ARNI group were younger,had more males,had a higher proportion of smoking and drinking,and had lower systolic blood pressure(all P<0.05).There were no significant differences in heart rate and length of hospital stay among the three groups(all P>0.05).3.In terms of drug use,the use rates of diuretics,β-blockers,spironolactone,and digoxin in the ARNI group were significantly higher than those in the ACEI/ARB group and the control group,and the differences were statistically significant(all P<0.05).4.In terms of cardiac function,the LVEF of patients with heart failure in the ARNI group was significantly lower than that in the ACEI/ARB group and the control group,and the difference was statistically significant(all P<0.05).The proportion of HFrEF in ARNI group was 50.3%(141 cases),which was significantly higher than that in ACEI/ARB group and control group,and the difference was statistically significant(P<0.05).In terms of cardiac structure,the left ventricular end-diastolic diameter,the left atrial end-systolic diameter,the right ventricular end-diastolic diameter and the right atrial end-systolic diameter in the ARNI group were higher than those in the ACEI/ARB group and the control group,with statistical significance(all P<0.05).The baseline of NT-proBNP in ARNI group was 3054(1764,7584)pg/mL,which were higher than those in ACEI/ARB group and control group,and the difference was statistically significant(all P<0.05).There was no significant difference between the ACEI/ARB group and the control group in the above-mentioned LVEF,cardiac structure,HFrEF ratio and NT-proBNP(all P>0.05).5.The eGFR in the ARNI group was lower than that in the ACEI/ARB group and the control group,but in terms of creatinine,uric acid,serum potassium,and ALT,the ARNI group was higher than the ACEI/ARB group and the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the above indicators between the ACEI/ARB group and the control group(P>0.05).6.Of the 1501 hospitalized patients with heart failure,280(18.7%)received sacubitril/valsartan.Among them,the usage rates of the first and last eight months were 11.3%(76 cases)and 24.7%(204 cases),and the difference was statistically significant(all P<0.05).7.In hospitalized patients with heart failure,the common starting doses of sacubitril/valsartan were 50 mg/d and 100 mg/d,and the proportions were 41.8%and 43.9%,respectively.At the sixth month of follow-up,the proportions of patients using 100 mg/d and 200 mg/d doses were 44.9%and 42.9%,respectively,and 4 patients(8.1%)reached the target dose of 400 mg/d.8.After treatment,the systolic blood pressure,heart rate,and NT-proBNP of patients with heart failure in the ARNI group were 117.2±16.6mmHg,73.9±9.1 beats/min,and 2613(1134,5299)pg/mL at discharge,respectively.Compared with before treatment were significantly reduced,the difference was statistically significant(P<0.05).Compared with before treatment,the eGFR of the heart failure patients in the ARNI group was further reduced at discharge,and the creatinine,urea,and uric acid were all increased,and the differences were statistically significant(all P<0.05).9.Compared with the ACEI/ARB group,the eGFR in the ARNI group was further decreased after treatment,and the creatinine,urea,and uric acid were further increased,and the differences were statistically significant(P<0.05).10.At admission,1 month of treatment,and 6 months of treatment,the usage rates of diuretics in the ARNI group were 89.3%,59.0%and 37.7%,respectively;the usage rates of beta-blockers were 79.3%,78.7%,and 71.4%,respectively;the utilization rates of spironolactone were 91.1%,72.1%,and 44.9%,respectively;the ratios of digoxin usage were 45.0%,29.5%,and 18.4%.During the treatment period,the proportion of patients who used diuretics,spironolactone,and digoxin showed a downward trend,while the proportion of patients who used β-blockers did not change significantly.11.In terms of heart failure rehospitalization rate,the ARNI group and ACEI/ARB group were 7.9%vs 13.2%and 20.0%vs 23.8%at the first and sixth months of follow-up,respectively,with no statistical difference.significance(all P>0.05).Conclusion:1.In the real world,patients using sacubitril/valsartan were characterized by younger age,lower blood pressure,poorer cardiac function and structure,and more kidney damage than nonusers,requiring more co-administration of anti-heart failure drugs.2.In the real world,sacubitril/valsartan has the characteristics of low starting dose and low target dose achievement rate in heart failure patients in ourcenter.3.In the real world,vigilance is required when using sacubitril/valsartan,which may aggravate kidney damage in patients with heart failure. |
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