Comparative Treatment Of The Actual Dose Of Sacubitril-Valsartan Versus Target Dose Of Acei In Patients With Heart Failure With Reduced Ejection Fraction

Objectives:A retrospective analysis was made of the dose of Sacubitril-Valsartan used in the Second Affiliated Hospital of Nanchang University in the real world for the treatment of heart failure patients with decreased ejection fraction,and the therapeutic effect of angiotensin converting enzyme inhibitors(ACEI)compared with the target dose on the treatment of heart failure patients with decreased ejection fraction(HFrEF).METHODS:This study was a retrospective enrollment observational cohort study.Continuity was included in our hospital from September 2017 to December 2018 in 223 patients with dilated cardiomyopathy(DCM)and heart failure(HF),divided into observation group and standard group.The observation group was initially given orally with Sacubitril Valsartan Sodium Tablets,50 mg twice daily,and the dose was adapted according to the patient’s blood pressure,tolerance,and doctor’s willingness.The standard group was given an ACEI orally,starting from a small dose and gradually increasing until the target dose was reached.Follow-up treatment for 18 months,observe the improvement of symptoms and cardiac function in patients with HFrEF in the real world,the number of re-admission days and the number of times,the dose of drugs,etc.,cardiac structure,6-min walk test,Minnesota living with heart failure questionnaire(MLHFQ)scores,Brain natriuretic peptide(BNP),blood routine and renal function,and event rates.Results:In the treatment of HFrEF in real-world,the average dose of Sacubitril-Valsartan was 138.96±67.22 mg,and the target dose rate was 1.8%.The target dose achieved in the standard group was 47.3%.Days and times of readmitted in the observation group,MLHFQ score and BNP after treatment were all lower than the standard group,and the 6min walking test and clinical effective rate were higher than the standard group(P < 0.05).The decrease of systolic blood pressure in the observation group was higher than that in the standard group((35)(?) =-7.9 mmHg,P=0.000).The decrease in platelet count before and after treatment in the standard group was much higher than that in the observation group((35)(?) =-14.64x10*9/L,P=0.009).The hemoglobin of the observation group was significantly decreased before and after treatment(P<0.05).There was no significant difference in cardiac structure and function,renal function,blood lipids,glycosylated hemoglobin and electrolytes between the two groups(P>0.05).In the subgroup analysis,the average dose of Sacubitril-Valsartan in the observation group was 115.27±53.65 mg,and no one reached the target dose.After treatment,the left ventricular end-diastolic diameter,MLHFQ score and BNP in the two groups were all lower than before treatment,while the left ventricular ejection fraction and 6min walking test were all increased compared with before Sacubitril-Valsartan,there was no significant difference between the two groups(P>0.05).Conclusions:In the treatment of HFrEF in the real world,most patients treated with Sacubitril-Valsartan did not reach the target dose;compared with the target dose of ACEI,The commonly used dose of Sacubitril-Valsartan is not inferior to the target dose of ACEI in the treatment of patients with chronic heart failure,and the improvement of clinical symptoms is more prominent.Patients with HF with systolic blood pressure of less than 100 mmHg also benefit from Sacubitril-Valsartan.