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Inpatient versus outpatient introduction of angiotensin receptor neprilysin inhibitor in chronic heart failure patients

Session Poster Session 2

Speaker Mehdi Aleyan

Event : Heart Failure 2019

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

Authors : M Aleyan (Lyon,FR), N Mewton (Lyon,FR), C Bergerot (Lyon,FR), L Green (Lyon,FR), E Hugon-Vallet (Lyon,FR), M Ovize (Lyon,FR), L Sebbag (Lyon,FR)

M Aleyan1 , N Mewton2 , C Bergerot2 , L Green3 , E Hugon-Vallet3 , M Ovize2 , L Sebbag4 , 1Civils Hospices of Lyon - Lyon - France , 2Hospital Louis Pradel of Bron, Centre d’Investigation Clinique, UMR Inserm 1407 - Lyon - France , 3Hospital Louis Pradel of Bron, Filière Insuffisance Cardiaque, CHU Louis Pradel - Lyon - France , 4Civils Hospices of Lyon, Pôle Transplantation Cardiaque, CHU Louis Pradel - Lyon - France ,

Chronic Heart Failure – Treatment

BACKGROUND: According to current guidelines, angiotensin receptor neprilysin inhibitors (ARNIs) are indicated in ambulatory patients with chronic heart failure (HF) and reduced ejection fraction (EF).

PURPOSE : To assess the safety and effects of ARNI introduction in HFrEF inpatients compared to outpatients in a retrospective single-center registry.

METHODS : In an observational retrospective and mono-centric registry at our institution we included all HFrEF patients who received a Sacubitril/Valsartan prescription from July 2015 to November 2016 . All patient data was recorded in their medical files at baseline at follow-up at 6 months for safety, and efficacy. Patients were retrospectively classified into 2 groups according to ARNI introduction mode: inpatient or outpatient.

RESULTS : 89 patients were included in our registry: 49 were outpatients and 40 inpatients. Mean systolic blood pressure at ARNI start was similar between outpatients and inpatients (117±15 versus 110±16 mmHg, respectively; p=0.06) as was glomerular filtration rate (GFR) (67.8±26.1 versus 64.0±25.2 ml/min, respectively; p=0.49). At 6 months follow-up, ARNIs had been continued in 90% of the outpatients versus 92% of the inpatients (p=0.79). There was a trend toward more symptomatic hypotension episodes in the inpatient group compared to the outpatient group (30,7% versus 18.6%, respectively; p=0.2) but GFR remained similar between groups (66.8±29 vs 59.5±25 ml/min; p=0.23) and the was no difference in hyperkalemia incidence between the outpatient and inpatient groups (4.7 versus 7.8%, respectively; p=0.56). In both groups, there was a significant improvement in NYHA class and LVEF at 6 months compared to baseline status.

CONCLUSIONS : In a monocentric observational registry, there was no significant difference in safety and efficacy in ARNI prescription between inpatients and outpatients with chronic HFrEF.

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