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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
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
,
Topic(s): 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.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
