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Reduction of loop diuretic requirements in HFrEF patients treated with Sacubitril/Valsartan

Session Poster Session 3

Speaker Cristina Goena Vives

Event : Heart Failure 2019

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

Authors : C Goena (Mendaro,ES), C Gomez (Barakaldo,ES), R Natividad (Barakaldo,ES), A Lozano (Bilbao,ES), V Escolar (Bilbao,ES), A Laskibar (Bilbao,ES), A Romero (Galdakao,ES), G Zugazabeitia (Galdakao,ES), I Rodriguez (Galdakao,ES), L Quintas (Mendaro,ES), P Gil (Vitoria,ES), I Solla (Donostia,ES), I Rilo (Donostia,ES), I Urreta (Donostia,ES), M Perez De Nanclares (Vitoria,ES)

Authors:
C Goena1 , C Gomez2 , R Natividad3 , A Lozano4 , V Escolar4 , A Laskibar4 , A Romero5 , G Zugazabeitia5 , I Rodriguez5 , L Quintas1 , P Gil6 , I Solla7 , I Rilo7 , I Urreta8 , M Perez De Nanclares6 , 1Mendaro Hospital, Cardiology - Mendaro - Spain , 2Cruces University Hospital, Cardiology - Barakaldo - Spain , 3San Eloy Hospital, Cardiology - Barakaldo - Spain , 4Basurto University Hospital, Cardiology - Bilbao - Spain , 5Galdakao Hospital, Cardiology - Galdakao - Spain , 6Araba University Hospital, Cardiology - Vitoria - Spain , 7Donostia University Hospital, Cardiology - Donostia - Spain , 8Donostia University Hospital, Epidemiology - Donostia - Spain ,

Citation:

Introduction: The requirement and dose of loop diuretics is a functional and useful marker in HFrEF symptom control. Sacubitril/Valsartan (SV) decreases mortality in HFrEF patients. In addition, it exists certain evidence supporting that SV improves the functional situation and diminishes the need for loop diuretics in these patients; however, there was no difference in the mean daily dose of furosemide in the PARADIGM-HF trial.
Purpose: To analyze the percentage of change in loop diuretic doses three months after having reached the maximum tolerated dose of SV in a real-life population.
Methods: Retrospective multicenter study of HFrEF outpatients (NYHA=II and LVEF<40%) with optimized medical/devices treatment starting on SV initiation. Data was recorded at baseline and three months after having reached the maximum tolerated SV dose (three SV dose categories were defined: low <150 mg/24h, medium 150-200 mg/24h and high =300 mg/24h). Admissions, diuretic dose adjustments and pre-renal events were recorded during follow-up.
Results: The study population was made up of 260 patients: 75% men, 69±10 years and NYHA class II: N=120 (44%); II-III: N=95 (35%); III: N=58 (21%). Main comorbidities were: hypertension (64.5%), diabetes (35%), ischemic cardiomyopathy (IC) (49.4%) and severe myocardial infarction (13.5%). Most frequent baseline medications were: BB (89%), MRA (76%) and ACEI/ARB (86.7%). The number of patients that reached the different SV dose categories were: low: N=65 (25%), medium: N=100 (38.46%) and high: N=95 (36.53%). Final SV doses were higher in men (p=0.003), IC (p=0.02), use of BB (p=0.03) and previous intake of ACEI/ARB (p=0.006). Most common adverse events were: HF hospitalization (13%), non-HF hospitalization (9%), diuretic adjustment (27%) and pre-renal events (12.5%). At the end of the monitoring, a reduction in loop diuretic doses was observed in 32% (N=84; p<0.0001) of patients treated with furosemide; whereas, no change was observed in patients treated with torasemide (N=11; non-significant). An increase in loop diuretic doses was observed in 7% of the patients (N=18); the rest of the population did not experience any change. Furosemide withdrawal was achieved by 16.5% (N=43) of the population. Patients receiving higher doses of SV were more likely to reduce diuretic dose when compared to the low-dose group (p=0.012). Furthermore, these findings were associated with an improvement in NYHA class.
Conclusions: This study shows that the use of SV is associated with a clinically-relevant loop diuretic dose reduction (exceeding 30%) in a short period of time; in addition, it shows that this reduction occurs more frequently in patients who tolerate higher doses of SV. The reduction of the daily needs for loop diuretics is an objective parameter that allows clinicians to corroborate the benefit in the functional situation of a patient treated with SV.

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