1E-Da hospital, cardiovascular department - Kaohsiung - Taiwan, Province of China
Current study focused on a retrospective cohort; we characterize the real-world timing of S/V initiation.
This is a single center retrospective cohort study from January 2017 to December 2018 in our hospital, focusing on patients switched to S/V. Patients were divided into three groups: Group 1. Patients switched to S/V at outpatient clinic without recent heart failure admission; Group 2. Switched at outpatient clinic with recent (within 1 month) heart failure admission; and Group 3. Switched during heart failure hospitalization after hemodynamic stabilization.
A total number of 162 patients switched to S/V during January 2017 to December 2018 in our hospital. There were 91 patients in Group 1, 29 in Group 2, and 42 in Group3. Among these three group patients, there is no significant difference between baseline characteristics on factors such as age, gender, diabetes, atrial fibrillation, history of stroke, ischemic etiology of heart failure, prior hospitalization rate and baseline LVEF. However, heart failure status for patients in Group 3 were much severe(NYHA class P< 0.05) and the length of index hospitalization was longer in Group 3 than Group 2 (13.5 ± 7.7 vs 7.9 ± 6.5 days, P<0.05).
Initiation dose and titration pattern were similar between these three groups.
At 1 year follow-up, there were 7 cases discontinue S/V(2 hypotension, 2 acute kidney injury, 1 cough and 2 physician choice) in Group 1(N=53), 3(1 hypotension and 2 physician choice) in Group 2(N=17) and 5(2 hypotension and 3 physician choice) in Group 3(N=26). Although compared with Group 1, baseline characteristics of Group 2 and 3 showed higher BNP level and much severe NYHA class, treatment withdraw due to side effect of drug were all rare.
At 1 year follow-up, 2 cases died in Group 1, 1 in Group 2, and 3 in Group 3.
Among these three groups, there were 9 patient heart failure rehospitalization within 1 year at Group 1(N=53), 6 in Group 2(N=17), and 14 in Group 3(N=26). In Group 3, there are 14 cases readmitted within 1 year after S/V treatment. Mean length of heart failure hospitalization(LOH) in these 14 patients was 17 days before treatment and 14 days after treatment. 6 patients readmitted in Group 2, and decreased LOH from 8(before treatment) to 5.3(after treatment) days.
Among these three groups, the LVEF presented at baseline characteristics were indicated as 32 ± 8, 32 ± 8 and 34 ± 10% (P=0.352639). After S/V treatment, all three groups presented improvement in LVEF, with 37.4 ± 13.6% in Group 1, 48.7 ± 16.3% in Group 2, and 34.4 ± 12% in Group 3. Notably, a 16.3 % improvement was observed in Group 2.
Initiation of S/V in stabilized post-acute HFrEF patients seemed to be safe in real-world setting. Treatment withdraw due to side effect was rare. A reduced length of stay for heart failure re-hospitalization were observed within 3 month in both Group 2 and Group 3.