Observation Of Low-dose Sacubitril/Valsartan In Reduced Ejection Fraction In Chronic Heart Failure

Objective:To observe the efficacy of low-dose Sacubitril/Valsartan(ARNI)on chronic heart failure with reduced ejection fraction(HFrEF),and to clarify the efficacy and safety of low-dose Sacubitril/Valsartan in HFrEF,so as to provide reference for the clinical application of low-dose Sacubitril/Valsartan..Methods:In this retrospective study,a total of 462 patients with chronic heart failure(HFrEF)with decreased ejection fraction admitted to Ganzhou Hospital of Guangdong Provincial People’s Hospital(Ganzhou Municipal Hospital)from January 2020 to January 2022 were continuously selected,and 224 patients were finally screened out according to strict inclusion and exclusion criteria.They were divided into low-dose ARNI group(115 patients)and low-dose ARB group(109 patients)according to different medication regiments.All patients received other daily life management(health education,low-sodium diet,water intake control,weight management)and anti-heart failure treatment recommended by the guidelines(β-blockers,aldosterone receptor antagonists,diuretics,etc.).At the beginning of the study,patients’ basic clinical information was collected by querying the electronic medical record system,including gender,age,height,weight,co-morbidity,and co-medication.NYHA cardiac function grading was used to evaluate the cardiac function level of the subjects before treatment and after an average of 6 months of treatment.LVEF,LAD,LVDD,LVPWd and other indexes of the patients were detected by cardiac color Doppler ultrasound.Systolic blood pressure,diastolic blood pressure,renal function,electrolyte,NT-proBNP and other indexes were monitored before and after treatment.The patients were recorded whether adverse drug reactions occurred during medication,including hypotension,hyperkalemia and renal function injury.The number of hospitalizations due to acute aggravation of chronic heart failure,length of stay and adverse prognostic events were recorded.Post-treatment data were mainly obtained through follow-up visits(including telephone or wechat communication)or by consulting case information.Based on the above clinical data,the effectiveness and safety of the two treatment schemes were analyzed and compared.Results:1.Before the study,there were no statistical differences between the two groups in age,gender,BMI,previous disease history,blood pressure and other baseline data(P<0.05),and there were no statistical differences between the two groups in NT-proBNP,renal function,NYHA grade and cardiac color ultrasound data(LVEF,LVDD,LVPWd)and other indicators(P<0.05).2.After 6 months of treatment,the low-dose ARNI group was significantly better than the low-dose ARB group in improving cardiac ultrasound indicators,improving cardiac function grade and reducing NT-proBNP.The mean hospitalization times and total hospitalization days in low-dose ARNI group were lower than those in low-dose ARB group,but there was no statistical significance.Compared with low-dose ARB group,the incidence of renal damage,hypotension and hyperkalemia was lower in low-dose ARNI group,but there was no statistical significance.During follow-up,there was no difference between the two groups in acute heart failure admission,thromboembolic events,malignant arrhythmia and other adverse events.3.For HFrEF patients with hypertension,the low-dose ARNI group had no obvious advantage over the ARB group in reducing blood pressure,and the low-dose ARNI group was superior to the low-dose ARB group in improving cardiac function indexes such as LVEF,LVDd,LVPWd,NHYA and NT-proBNP.There were no significant differences in hypotension,hyperkalemia and renal function impairment between the two groups.Conclusion:1.Low-dose ARNI can effectively improve the cardiac function and ventricular remodeling in patients with HFrEF,reduce the average number of hospitalizations and length of stay,reduce the occurrence of adverse prognostic events,and does not increase the risk of hypotension,hyperkalemia,renal damage,etc.2.For HFrEF patients with hypertension,small dose of ARNI is safe and effective.