| Background and ObjectiveHeart failure(HF)can be broadly defined as a group of clinical syndons associated with structural damage or dysfunction of the Heart,accompanied by symptoms of dyspnea or fatigue that limit the patient’s tolerance for daily living and exercise.The symptoms of many heart failure patients are gradual and can last several days to weeks.HF is the ultimate outcome of a variety of heart diseases.With the progress of the aging population and the progress of the treatment of heart diseases,the number of patients with Chronic heart failure(CHF)is gradually increasing around the world.Acute decompensated heart failure(ADHF)is a symptomatic aggravating event in the course of CHF,acute ischemic events of coronary heart disease lead to structural abnormalities of left ventricle or sharp decline in systolic function,combined infection on the basis of original cardiac dysfunction,arrhythmia,sudden aggravation of cardiac load or improper treatment are all common inducing factors of ADHF.ADHF is a decompensated event in the course of CHF,and patients will have obvious heart failure symptoms or aggravation of the original symptoms.Therefore,ADHF is the direct cause of the first or second admission of patients with heart failure.As a common cardiovascular emergency in cardiovascular medicine,it is necessary to correct the heart function quickly and alleviate the clinical symptoms of patients.Inhibition of long-term chronic activation of neuroendocrine system,postponement and reversal of cardiac remodeling are the main treatment measures for CHF.For a long time,Angiotensin converting enzyme inhibitors/Angiotensin receptor blockers(ACEI/ARB),Aldosterone receptor antagonist and β-receptor blockers have been the main drugs for the treatment of CHF and improving its prognosis.They can effectively reduce the mortality rate and readmission rate of CHF patients,and improve the prognosis and quality of life of patients.Angiotensin receptor neprilysin inhibitor(ARNI)can be used in addition to ACEI to further reduce cardiovascular events in patients with Heart failure with reduced ejection fration(HFrEF)(PARADIGM-HF,2014)has been recommended by several leading guidelines[ESC 2016 Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure(I,B),2017 American College of Cardiology/American Heart Association(ACC/AHA)Guidelines for the Management of Heart Failure(I,B),2018 Guidelines for the Diagnosis and Treatment of Heart Failure in China(I,B)],however,the use of this drug in the treatment of ADHF is still exploratory,and there are currently studies showing that(PIONEER-HF,2018;TRANSITION,2018),after hemodynamically stable in ADHF patients,this drug can more significantly reduce the level of NT-proBNP in patients compared with ACEI,bringing more clinical benefits.However,in the hospital treatment of ADHF,there has been no relevant research to confirm whether this drug can control the symptoms of patients faster than ACEI,reduce the length of hospital stay of patients,reduce the dose of diuretic in the venous cycle,and reduce the incidence of common adverse events in the treatment of heart failure,such as electrolyte disturbance.In this study,by comparing the differences in hospitalization period,diuretic dose in venous ansa,the incidence of electrolyte disturbance,the incidence of other adverse events,the improvement of the quality of life and the readmission rate of the patients within 3 months after treatment between Sacubitril/Valsartan(Noxintone)and Enalapril in the in-hospital treatment of ADHF patients,to evaluate the safety and effectiveness of the drug in the hospital treatment of ADHF,and explore a new method for the hospital treatment of ADHF.MethodsADHF patients admitted to our hospital due to decompensed events from June 2019 to December 2019 were selected.According to the different treatment plans,164 ADHF patients in the Noxintone group and the control group were randomly screened out from the patients meeting the standards of sodium discharge,with a total of 328 cases in the two groups.Based on the conventional anti-heart failure treatment,the Noxintone group and the control group were treated with Noxintone and Enalapril respectively.1.Main observation indicators:①Patients in the two groups received corresponding treatment in hospital,and those who met the criteria of discharge according to the evaluation criteria of efficacy were compared for the difference in hospitalization period;②Differences in the diuretic dose in venous ansa(referring to the intravenous dosages of furosemide in hospital),the incidence of electrolyte disturbance and the rate of readmission within 3 months between the two groups.2.Secondary observation indicators:①Changes in NT-proBNP、systolic and diastolic blood pressure levels as myocardial markers;②The changes of 6-minute walking test(6MWD),an indicator of cardiac function improvement.SPSS 22.0 software was used for statistical analysis of all data The differences were considered statistically significant at P<0.05.Results1.Compared with the control group,patients in the Noxintone group had shorter hospitalization period,significantly reduced the diuretic dose in venous ansa,lower incidence of electrolyte disturbance,and lower readmission rate within 3 months,with statistical significance(P<0.05).2.After treatment,NT-proBNP was decreased and 6MWD was increased in both groups,but the improvement was significant in the Noxintone group,and the difference between the two groups was statistically significant(P<0.05).Conclusions1.Compared with Enalapril,Sacubitril/Valsartan can significantly reduce the diuretic dose in venous ansa and the incidence of electrolyte disturbance;2.Compared with traditional ACEI drugs,Sacubitril/Valsartan can further shorten the hospitalization period and readmission rate of ADHF patients within 3 months,and significantly improve the long-term prognosis;3.Compared with traditional ACEI drugs,Sacubitril/Valsartan can significantly improve patients’ cardiac function and exercise tolerance. |
PDF Full Text Request