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Response rate to sacubitril-valsartan in the community. Is there a clear phenotype?

Session Poster Session 2

Speaker Rebabonye Pharithi

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : R B Pharithi (Dublin,IE), M Ferre-Vallverdu (Dublin,IE), E O'connell (Dublin,IE), M Walshe (Dublin,IE), J Barton (Dublin,IE), D O'hare (Dublin,IE), C Sweeney (Dublin,IE), F Rathore (Dublin,IE), K Mcdonald (Dublin,IE), J Gallagher (Dublin,IE), C Watson (Dublin,IE), M Ledwidge (Dublin,IE), K Mcdonald (Dublin,IE)

Authors:
R B Pharithi1 , M Ferre-Vallverdu1 , E O'connell1 , M Walshe1 , J Barton1 , D O'hare1 , C Sweeney1 , F Rathore1 , K Mcdonald1 , J Gallagher1 , C Watson1 , M Ledwidge1 , K Mcdonald1 , 1St Vincent's University Hospital, Heart Failure Unit - Dublin - Ireland ,

Citation:

Introduction
Several clinical trials have now shown that the combination ARNI, sacubitril-valsartan (S-V) significantly improves mortality and morbidity among HF-REF patients. Real world experience is less expansive and it is unknown if there is a particular clinical phenotype with HF-REF who are more likely to respond.

Methods
To assess patient responsiveness to S-V in a community from May 2016 to present. All patients have had defined stable HF-REF on maximal tolerated disease modifying therapy. Response to S-V definition: 30% reduction in NT-proBNP and/or a 5% increase in LVEF(LVEF taken =2 mths post last titration). Univariate and multivariable analyses were used.

Results
322 HF-REF patients were commenced on S-V (median age 70 [61.9-76.2] years; male 75.1%). All patients were on ACEi/ARB prior to S-V. 90.7% were prescribed beta-blockade and 71.9% MRA. 12.4% did not tolerate S-V. 7.7% in titration were excluded. 46.3% met the NT-proBNP criteria for responder status while 49.3% had LVEF increase by >5%. 78.4% met either responder criteria components (table 1). Non-responder patients were older, hypertensive, and had more CKD, ischaemia and atrial fibrillation (all p=0.5). Absence of ischaemia was the only independent predictor to response (p=0.018). Diuretics were decreased in 37.2% of patients. Mean reduction of 10±37mg.

Conclusion:
Though majority of patients responded to sacubitril-valsartan, non-responders had increased disease burden. Responders were younger, had better renal function and required diuretic dose decrease.

PATIENTS MEETING RESPONDER CRETERIA

n/N

NTproBNP down >30% from T1 to follow up

99/214 (46.3%)

LVEF up >5% from T1 to follow up

70/142 (49.3%)

NTproBNP down >30% AND LVEF > 5%

35/185 (18.9%)

NTproBNP down >30% OR LVEF > 5%

134/171 (78.4%)

Diuretic decrease

93/250 (37.2%)

PHENOTYPICAL DEFFERENCE

Phenotypical features

Non-Responder

Responder

p-value

Age

71.4(62.7,77.6) 65.1(56.3,72.5)

0.001

eGFR

58(44,70) 71(55,81)

0.01

HTN

56/150 (37.3%) 6/35 (17.1%) 0.038
Ischaemic Cardiomyopathy 42/146 (28.8%) 1/34 (2.9%)

0.001

AF 74/150 (49.3%) 9/35 (25.7%) 0.019

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