OSAMA A AMİN, AHMED F ALAARAG
The Anatolian Journal of Cardiology - 2021;25(3):163-169
Objective: Many trials confirmed the role of sacubitrilvalsartan in the treatment of patients with heart failure with reduced ejection fraction (HFrEF). However, there is no sufficient data to register the effect of compulsory discontinuation of sacubitrilvalsartan, either because of finan-cial shortage or adverse effects, and shifting to the standard therapy, including angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). METHODS: The patients with HFrEF (LVEF ≤35%) were included in the study. They received treatment with sacubitrilvalsartan as a replacement for an ACEI or ARB. The patients were divided into two groups: the compliant group (n=111). The non-compliant group (n=82), whose members discontinued sacubitrilvalsartan after ≥5 months but <6 months since their enrollment in the study. Results: Initially, 199 patients with HFrEF were included in the study. All the patients were started treatment with sacubitrilvalsartan in addition to the evidence-based standard therapy of heart failure. Six patients were excluded at the first follow-up visit (at 6 months). The remaining 193 patients showed initial improvement of the New York Heart Association (NYHA) class, the end-diastolic volume (EDV), and the left ventricular ejection fraction (LVEF). Five patients were excluded at the 12 months’ follow-up visit. The other 188 patients were divided into two groups: Group I (n=108) patients were compliant on sacubitrilvalsartan for 12 months; Group II (n=80) patients were compliant on sacubitrilvalsartan for ≥5 months, but stopped it at <6 months, and were shifted to ACEI or evidence-based ARB. Group II (n=80) patients showed worsening of their NYHA class, compared to the 6 months’ follow-up visit (p=0.001). LVEF and EDV were also shown to be worsened in these patients when we compared them to the values of the 6 months’ follow-up appointment with p=0.001 for both parameters. Conclusion: The discontinuation of sacubitrilvalsartan in patients with HFrEF leads to deterioration of the LVEF as well as worsening of the functional class. The decline in LVEF and NYHA functional class occurs despite being compliant with the optimal conventional therapy with ACEI or evidence-based ARB.