Observation Of The Clinical Efficacy Of Sacubitril/Valsartan Combined With Digoxin On Refractory Heart Failure

ObjectiveTo observe the clinical efficacy and safety of sacubitril/valsartan combined with digoxin in the treatment of refractory heart failure.MethodsA collection of 100 patients with refractory heart failure(RHF)who received treatment from the Department of Cardiology and Critical Care Medicine,Affiliated Central Hospital of Shenyang Medical College from June 2019 to June 2020.They were randomly divided into non-combined medication group(sacubitril/valsartan+conventional treatment)and combination medication group(sacubitril/valsartan+digoxin+ conventional treatment).Patients in both groups were treated for 24 weeks.Cardiac ultrasound and six-minute walk test were performed before treatment,8 weeks,16 weeks and 24 weeks after treatment to monitor the plasma levels of NT-pro BNP in the two groups.At the same time,the Minnesota Heart Failure Quality of Life Scale was filled in to evaluate the patient’s quality of life.The improvement of heart failure symptoms,NYHA heart function classification,changes in LVEF,LVEDD and LiHFe scores were observed between the two groups of patients,and major adverse cardiovascular events were recorded.Results1.Follow-upFrom the time of the first patient’s enrollment(2019-07)to the end of the experimental observation(2021-01),a total of 101 patients were enrolled,of which 51 cases were in non-combined medication group,1 case was lost to follow-up,and 50 cases were completed in combination medication group,50 cases completed follow-up.2.Patient baseline characteristicsThere were no significant differences in age,gender,NYHA heart function classification and LiHFe score between the two groups before treatment(P>0.05).3.Improvement of heart failure symptoms before and after treatment in the two groupsThere was no significant difference in LiHFe score,NYHA classification and 6MWD before treatment between the two groups(P>0.05).The LiHFe score(79.53±6.37 vs.75.94±6.47;P=0.009)and the 24-week NYHA score(2.60±0.81 vs.2.02±1.01;P=0.003)of 16 weeks of treatment were significantly lower in combination medication group than in non-combined medication group.At 24 weeks,the 6MWD of combination medication group was significantly more than that of non-combined medication group(324.02±91.90m vs.402.51±104.65m;P<0.001).4.The improvement of cardiac structure and cardiac function of the two groups of patients before and after treatment(1)Comparison of the two groups of LVEDD:The LVEDD of the patients in non-combined medication group was significantly smaller than that before treatment(62.42±4.63mm vs.64.91±5.12mm;P=0.001),and the LVEDD of patients in combination medication group was significantly smaller than that before treatment(63.13±5.90mm vs.66.21±6.38mm;P<0.001).Both non-combined medication group or combination medication group can significantly reduce the LVEDD of patients,and there is no difference in the degree of reduction of LVEDD between the two treatment options(P>0.05).(2)Comparison of NT-pro BNP and LUEF between the two groups:There was no statistical difference in NT-pro BNP and LVEF between the two groups of patients before treatment(P>0.05),and there were statistical differences in NT-pro BNP between the two groups of patients after 8 weeks of treatment,combination medication group Compared with non-combined medication group,the decrease was more significant(3955.00±1443.21pg/ml vs.4819.62±1361.97pg/ml;P=0.004).There was a statistically significant difference in LVEF between the two groups of patients after 24 weeks of treatment,and the increase in combination medication group was more significant than non-combined medication group(46.20± 2.86%vs.43.80±3.66%;P=0.001).5,The incidence of MACE events in the two groupsThere was no significant difference in the incidence of MACE events between the two groups of patients after 24 weeks of treatment(16%vs.22%,χ2=0.585,P=0.444>0.05).Conclusion1.Both therapies of sacubitril/valsartan combined with digoxin and the simple application of sacubitril/valsartan can improve the symptoms of refractory heart failure and improve the quality of life of patients,and the combined treatment group is the better.2.Both sacubitril/valsartan combined with digoxin and sacubitril/valsartan alone can reduce the left ventricular end diastolic dimension,suggesting that the two treatment options have the same effect on reversing left ventricular remodeling.3.Both treatments of sacubitril/valsartan combined with digoxin and sacubitril/valsartan alone can improve the left ventricular systolic function of patients,and the combined treatment group is better.4.For improving the prognosis of patients with refractory heart failure,sacubitril/valsartan combined with digoxin and sacubitril/valsartan alone have similar effects.