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To evaluate the safety and tolerability of ARNI initiation in inpatient versus outpatient setting in an Asian population: a real world study

Session Poster Session 2

Speaker Yiliang Zheng

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Treatment
  • Session type : Poster Session

Authors : Y Zheng (Singapore,SG), K Chng (Singapore,SG), JS Hon (Singapore,SG), H Chan (Singapore,SG), CY Khoo (Singapore,SG), CT Ng (Singapore,SG), L Teo (Singapore,SG), D Sim (Singapore,SG)

Y Zheng1 , K Chng1 , JS Hon1 , H Chan1 , CY Khoo1 , CT Ng1 , L Teo1 , D Sim1 , 1National Heart Centre Singapore, Cardiology - Singapore - Singapore ,

Chronic Heart Failure – Treatment

Introduction: TRANSITION and PIONEER HF trials showed that entresto, an angiotensin receptor neprilysin inhibitor (ARNI), can be initiated early and safely in patients with heart failure reduced ejection fraction (HFrEF) shortly after an acute heart failure episode during hospitalization. However, it is unclear whether the results can be translated to the Asian population. 
Purpose: To compare the tolerability of ARNI initiation and continuation rate in both inpatient and outpatient settings. 
Methods: A retrospective review of all patients who were prescribed ARNI from 1 November 2015 to 30 September 2018 in a tertiary institution in Singapore was performed. Data on the incidence of adverse drug reactions (ADRs), continuation rate of ARNI and reasons for ARNI discontinuation were collected from electronic clinical documents. 1022 patients were identified. 287 of 339 patients in the Inpatient Group and 549 of 683 patients in the Outpatient Group were included. Exclusion criteria include missing data, defaulted medication and initiation of ARNI in another institution. 
Results: In the Inpatient Group, 89 patients (30%) experienced ADRs, 26 (30%) experiencing ADRs whilst inpatient and discontinuation rate is 48 (55%).  In the Outpatient Group, 93 patients (17%) experienced ADRs and discontinuation rate is 47 (51%). Reasons for discontinuation of ARNI in both groups were similar - common reasons include worsening kidney function and hypotension.
Conclusion: Although inpatient ARNI initiation may be associated with higher rates of ADRs, tolerability and continuation of ARNI are similar in both groups. This may provide further evidence that ARNI can be safely initiated inpatient and allows optimisation of treatment for patients with HFrEF.

Inpatient Group Outpatient Group Total
Total patients included 287 (34.3%) 549 (65.7%) 836
Male 209 (72.8%) 426 (77.5%)
Mean age ± SD 64 ± 12.1 62 ± 12.3
Mean EF before initiation of ARNI ± SD (%) 24 ± 7.2 26 ± 12.3
Mean SBP before initiation of ARNI ± SD (mmHg) 116 ± 17.8 121 ± 20.2
Total ADRs 87 (30%) 93 (17%) 180
Worsening kidney function 28 (32%) 11 (12%) 39
Asymptomatic hypotension 27 (31%) 20 (22%) 47
Symptomatic hypotension 21 (24%) 12 (13%) 33
Total discontinuation 48 (55%) 47 (51%) 95

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