PMID- 33690130
OWN - NLM
STAT- MEDLINE
DCOM- 20211015
LR  - 20211015
IS  - 2149-2271 (Electronic)
IS  - 2149-2263 (Print)
IS  - 2149-2263 (Linking)
VI  - 25
IP  - 3
DP  - 2021 Mar
TI  - The impact of discontinuation of sacubitril-valsartan and shifting to 
      angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in 
      patients with heart failure with reduced ejection fraction.
PG  - 163-169
LID - 10.14744/AnatolJCardiol.2020.39267 [doi]
AB  - OBJECTIVE: Many trials confirmed the role of sacubitril-valsartan in the 
      treatment of patients with heart failure with reduced ejection fraction (HFrEF). 
      However, there is no sufficient data to register the effect of compulsory 
      discontinuation of sacubitril-valsartan, either because of finan-cial shortage or 
      adverse effects, and shifting to the standard therapy, including 
      angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker 
      (ARB). METHODS: The patients with HFrEF (LVEF </=35%) were included in the study. 
      They received treatment with sacubitril-valsartan as a replacement for an ACEI or 
      ARB. The patients were divided into two groups: the compliant group (n=111). The 
      non-compliant group (n=82), whose members discontinued sacubitril-valsartan after 
      >/=5 months but <6 months since their enrollment in the study. RESULTS: Initially, 
      199 patients with HFrEF were included in the study. All the patients were started 
      treatment with sacubitril-valsartan in addition to the evidence-based standard 
      therapy of heart failure. Six patients were excluded at the first follow-up visit 
      (at 6 months). The remaining 193 patients showed initial improvement of the New 
      York Heart Association (NYHA) class, the end-diastolic volume (EDV), and the left 
      ventricular ejection fraction (LVEF). Five patients were excluded at the 12 
      months' follow-up visit. The other 188 patients were divided into two groups: 
      Group I (n=108) patients were compliant on sacubitril-valsartan for 12 months; 
      Group II (n=80) patients were compliant on sacubitril-valsartan for >/=5 months, 
      but stopped it at <6 months, and were shifted to ACEI or evidence-based ARB. 
      Group II (n=80) patients showed worsening of their NYHA class, compared to the 6 
      months' follow-up visit (p=0.001). LVEF and EDV were also shown to be worsened in 
      these patients when we compared them to the values of the 6 months' follow-up 
      appointment with p=0.001 for both parameters. CONCLUSION: The discontinuation of 
      sacubitril-valsartan in patients with HFrEF leads to deterioration of the LVEF as 
      well as worsening of the functional class. The decline in LVEF and NYHA 
      functional class occurs despite being compliant with the optimal conventional 
      therapy with ACEI or evidence-based ARB.
FAU - Amin, Osama A
AU  - Amin OA
AD  - Department of Cardiology, Faculty of Medicine, Beni-Suef University; 
      Beni-Suef-Egypt.
FAU - Alaarag, Ahmed F
AU  - Alaarag AF
AD  - Department of Cardiology, Faculty of Medicine, Tanta University; Tanta-Egypt.
LA  - eng
PT  - Journal Article
PL  - Turkey
TA  - Anatol J Cardiol
JT  - Anatolian journal of cardiology
JID - 101652981
RN  - 0 (Aminobutyrates)
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Biphenyl Compounds)
RN  - 0 (Drug Combinations)
RN  - 0 (Tetrazoles)
RN  - 80M03YXJ7I (Valsartan)
RN  - WB8FT61183 (sacubitril and valsartan sodium hydrate drug combination)
SB  - IM
MH  - Aminobutyrates
MH  - Angiotensin Receptor Antagonists/therapeutic use
MH  - *Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Biphenyl Compounds
MH  - Drug Combinations
MH  - *Heart Failure/drug therapy
MH  - Humans
MH  - Stroke Volume
MH  - Tetrazoles/therapeutic use
MH  - Valsartan
MH  - Ventricular Function, Left
PMC - PMC8114728
COIS- Conflict of interest: None declared.
EDAT- 2021/03/11 06:00
MHDA- 2021/10/16 06:00
PMCR- 2021/01/18
CRDT- 2021/03/10 17:57
PHST- 2021/03/10 17:57 [entrez]
PHST- 2021/03/11 06:00 [pubmed]
PHST- 2021/10/16 06:00 [medline]
PHST- 2021/01/18 00:00 [pmc-release]
AID - ajc-25-3-163 [pii]
AID - 10.14744/AnatolJCardiol.2020.39267 [doi]
PST - ppublish
SO  - Anatol J Cardiol. 2021 Mar;25(3):163-169. doi: 
      10.14744/AnatolJCardiol.2020.39267.