Real world experience on angiotensin receptor and neprilysin inhibition in reduced ejection fraction heart failure patients with advanced chronic kidney disease. (25th November 2020)

• Record Type: Journal Article
• Authors: Hsu, C.Y; Chang, H.Y
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Heart Failure with Reduced Ejection Fraction; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.0936
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Angiotensin receptor and neprilysin inhibition (ARNI) reduces the risk of cardiovascular mortality among patients with heart failure with reduced ejection fraction (HFrEF) as compared with enalapril in the PARADIGM-HF trial. However, patients with glomerular filtration rate (GFR) less than 30 ml/min/1.73 m 2 or systolic blood pressure less than 100 mmHg were excluded from the PARADIGM-HF trial. We assessed the potential beneficial effects of ARNI in HFrEF patients with advanced chronic kidney disease (GFR<30 ml/min/1.73 m 2 ) by using a multicenter real-world data in Taiwan. Methods: The TAROT-HF (Treatment with Angiotensin Receptor neprilysin inhibitor for Taiwan Heart Failure patients) study is a multicenter study which enrolled 1, 694 HFrEF patients on ARNI treatment from 9 hospitals between March 2017 and December 2018. The data was compared to the outcome from the TSOC (the Taiwan Society of Cardiology)-HFrEF registry which enrolled 1, 509 HFrEF patients from 21 hospitals between 2013 and 2014 prior to era of ARNI. After 1:1 propensity score matching, a total of 1, 198 patients from the TAROT-HF study and 1, 198 patients from the TSOC-HFrEF registry were included for analysis. Results: During the 1 -year follow-up, the TAROT-HF cohort showed a significant superior prognosis on cardiovascular (CV) death (6.8% vs 10.6%, p<0.001) and all-cause death (8.5% vs 16.2, p<0.001) as compared with the TSOC-HFrEF study population. The patients were classified into 4 groups according to the renal function with eGFR values of <30, 30–59, 60–89, and ≥90 ml/min/1.73m 2, and there was no significant interaction between matched cohorts and renal function. The beneficial effects of ARNI on CV death and all-cause death were consistent across four eGFR groups, including 387 patients with eGFR<30 ml/min/1.73m 2 (16.2%). Conclusions: Our study demonstrated the effectiveness of ARNI on HFrEF patients in real world experience, including those with advanced chronic kidney disease with eGFR<30 ml/min/1.73m 2 . Funding Acknowledgement: Type of funding source: None