Clinical efficacy of angiotensin receptor-neprilysin inhibitor in de novo heart failure with reduced ejection fractionopen access
- Authors
- Park, Su Yeong; Kong, Min Gyu; Moon, Inki; Park, Hyun Woo; Choi, Hyung-Oh; Seo, Hye Sun; Cho, Yoon Haeng; Lee, Nae-Hee; Lee, Kwan Yong; Jang, Ho-Jun; Kim, Je Sang; Choi, Ik Jun; Suh, Jon
- Issue Date
- Aug-2023
- Publisher
- KOREAN ASSOC INTERNAL MEDICINE
- Keywords
- Angiotensin receptor-neprilysin inhibitor; Heart failure; Clinical outcome; Cardiac reverse remodeling; Worsening heart failure
- Citation
- KOREAN JOURNAL OF INTERNAL MEDICINE, v.38, no.5, pp 692 - 703
- Pages
- 12
- Journal Title
- KOREAN JOURNAL OF INTERNAL MEDICINE
- Volume
- 38
- Number
- 5
- Start Page
- 692
- End Page
- 703
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/25457
- DOI
- 10.3904/kjim.2023.065
- ISSN
- 1226-3303
2005-6648
- Abstract
- Background/Aims: We aimed to analyze the efficacy of angiotensin receptorneprilysin inhibitor (ARNI) by the disease course of heart failure (HF). Methods: We evaluated 227 patients with HF in a multi-center retrospective cohort that included those with left ventricular ejection fraction (LVEF) & LE; 40% undergoing ARNI treatment. The patients were divided into patients with newly diagnosed HF with ARNI treatment initiated within 6 months of diagnosis (de novo HF group) and those who were diagnosed or admittedfor HF exacerbation for more than 6 months prior to initiation of ARNI treatment (prior HF group). The primary outcome was a composite of cardiovascular death and worsening HF, including hospitalization or an emergency visit for HF aggravation within 12 months.Results: No significant differences in baseline characteristics were reported between the de novo and prior HF groups. The prior HF group was significantly associated with a higher primary outcome (23.9 vs. 9.4%) than the de novo HF group (adjusted hazard ratio 2.52, 95% confidence interval 1.06-5.96, p = 0.036), although on a higher initial dose. The de novo HF group showed better LVEF improvement after 1 year (12.0% vs 7.4%, p = 0.010). Further, the discontinuation rate of diuretics after 1 year was numerically higher in the de novo group than the prior HF group (34.4 vs 18.5%, p = 0.064).Conclusions: The de novo HF group had a lower risk of the primary composite outcome than the prior HF group in patients with reduced ejection fraction who were treated with ARNI.
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