Early Initiation of Sacubitril/Valsartan in Patients with Chronic Heart Failure After Acute Decompensation: A Case Series Analysis

• Published in: Clinical drug investigation Vol. 40; no. 5; pp. 493 - 501
• Main Authors: Acanfora, Domenico, Scicchitano, Pietro, Acanfora, Chiara, Maestri, Roberto, Goglia, Fernando, Incalzi, Raffaele Antonelli, Bortone, Alessandro Santo, Ciccone, Marco Matteo, Uguccioni, Massimo, Casucci, Gerardo
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-05-2020; Springer Nature B.V
• Subjects: Aminobutyrates - therapeutic use; Angiotensin Receptor Antagonists - therapeutic use; Biomarkers; Biomarkers - metabolism; Blood pressure; Cardiovascular disease; Chronic illnesses; Drug Combinations; Ejection fraction; Female; Heart failure; Heart Failure - drug therapy; Heart Failure - metabolism; Hospitalization; Humans; Inflammation; Internal Medicine; Lymphocytes; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Peptides; Pharmacology/Toxicology; Pharmacotherapy; Potassium; Prognosis; Proteins; Short Communication; Tetrazoles - therapeutic use; Walking
• ISSN: 1173-2563; 1179-1918
• DOI: 10.1007/s40261-020-00908-4

Background and Objective
Sacubitril/valsartan improved the prognosis of patients with heart failure with reduced ejection fraction in the PARADIGM-HF study. Recently, the TRANSITION and PIONEER-HF studies demonstrated the safety and efficacy of sacubitril/valsartan in patients hospitalized for acute decompensated heart failure, with treatment initiated after hemodynamic and clinical stabilization. In this case series study, we assessed the short-term effects of sacubitril/valsartan on exercise capacity, inflammation, and biomarkers in patients with acute decompensated heart failure.
Methods
Patients admitted for acute decompensated heart failure to the Department of Internal Medicine of Telese Terme Hospital and Cardiovascular Department, University of Bari, from 9 March, 2017 to 9 June, 2018 were enrolled. Following hemodynamic stabilization, patients initiated sacubitril/valsartan 24/26 mg twice a day for 4 weeks, with up-titration to 49/51 mg twice a day based on tolerability after 1 week. Efficacy outcomes included the 6-min walking test, N-terminal pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and lymphocyte count. Safety outcomes included renal function, hyperkalemia, and symptomatic hypotension.
Results
In total, 40 patients completed the study and 27 (67.5%) patients were up-titrated. Compared with baseline, exercise capacity and relative lymphocyte count increased significantly after 4 weeks of treatment, while N-terminal pro-B-type natriuretic peptide and high-sensitivity C-reactive protein decreased significantly. N-terminal pro-B-type natriuretic peptide and relative lymphocyte count independently predicted the 6-min walking test distance (
p
 = 0.021). No patients experienced any relevant side effects.
Conclusions
Early initiation of sacubitril/valsartan in patients with heart failure with reduced ejection fraction after acute decompensated heart failure may be safe and effective in terms of functional capacity and biomarkers.