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Reduced diuretic requirements in HFreF patients taking Entresto (ARNI)

Session Poster Session 3

Speaker Laura O'connor

Event : Heart Failure 2019

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

Authors : T Mannion (Dublin,IE), L O'connor (Dublin,IE), J Kelly O'haire (Dublin,IE), G O'gara (Dublin,IE), B Mcadam (Dublin,IE)

Authors:
T Mannion1 , L O'connor1 , J Kelly O'haire1 , G O'gara1 , B Mcadam1 , 1Beaumont Hospital, Supportive Heart Service - Dublin - Ireland ,

Citation:

Background:Post hoc analysis of PARADIGM-HF has shown treatment with Entresto was associated with greater diuretic dose reductions compared to Enalapril.

Purpose:To examine clinical & medication changes in HFrEF patients following treatment with ARNI.

Methods: Employing a One-Group Pre-Test Post-Test Design, data was collected on 90 HFrEF patients (74 male: 16 female) prior to initiating ARNI therapy & 12 months post achieving maximum tolerated dose. Indices of cardiac function were recorded (LVEF, LVIDd), biochemical measures (NTproBNP, potassium and creatinine), while medications were recorded & functional capacity was assessed using NYHA Classification. Paired sample t-test was completed to assess for significant changes.

Results: Dose reductions of both loop and thiazide diuretics- mean dose reduction for each diuretic drug (see figure 1). A statistically significant increase in LVEF of 7.9% (p0.00) and reduction in LVIDd of 0.4cm (p0.04) over the 12-month period. Also, a significant reduction in NYHA Classification (p 0.00) and NTproBNP levels (p0.01), with systolic BP reducing by mean 3.9 mmHg (p0.04). Serum Creatinine levels increased (p0.03), however there was no significant change in EGFR or serum potassium over time (see table 1). 

Conclusion(s):Diuretics are frequently used in HFrEF patients but are associated with electrolyte abnormalities and renal dysfunction. In this small investigation, treatment with ARNI was associated with more loop & thiazide diuretic dose reductions. This data suggests that treatment with ARNI results in reduced diuretic requirement. Additionally, a modest increase in LVEF with reduced LVIDd as measured by echo and a reduction in NYHA Classification was revealed.

pre post p
LVEF 25.9 ± 6.2 33.9 ± 9.5 0.00*
LVIDd 6.1 ± 1.3 5.7 ± 1.3 0.04*
NTproBNP 2252 ± 3486 1560 ± 1773 0.01*
NYHA Class (mean) 2.3 1.9 0.00*
Systolic BP mmHg 122.9 ± 17.8 119 ± 15.4 0.04*
Diastolic BP mmHg 72.1 ± 9.3 70.6 ± 8.7 0.21
Heart rate (bpm) 70.5 ± 10.4 70.9 ± 9.1 0.75
Weight (kg) 88.5 ± 23.9 88.9 ± 24.5 0.61
Serum Creatinine 105.5 ± 31.9 112.4 ± 36.1 0.03*
MDRD eGFR 76.1 ± 91.9 62.3 ± 25.1 0.12
Serum Potassium 4 ± 0.3 4.1 ± 0.4 0.15
Table 1

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