Background: Sudden cardiac death is a major healthcare issue in reduced ejection fraction heart failure (HFrEF) patients. Recently, the new association of sacubitril/valsartan showed a reduction of both ventricular arrhythmias (VA) and mortality even at low dose compared to enalapril in HF patients. The purpose of our study was to assess whether the highest dose of sacubitril/valsartan compared to lower doses may improve the rate of death and VA in a population of patients with HFrEF and with an implantable cardiac defibrillator (ICD).
Methods: 104 HF patients with reduced EF under sacubitril/valsartan with an ICD were divided in 2 groups: the first one with the lower doses of sacubitril/valsartan (24/26 mg or 49 mg/51 mg twice daily) and the second with the maximal dose (97mg/103mg twice daily). The primary outcome was a composite of death or appropriate ICD therapy for VA.
Results: After a median follow-up of 14 months, 39 patients were treated with lower doses and 65 patients with the highest dose. Patients from the lower doses group were older (70 [60-80] vs. 66 [60-70]; p = 0,03), more symptomatic at initiation (NYHA 3: 44% vs. 19%; p < 0,01) and more often in atrial fibrillation (31% vs. 12%; p = 0,04). The primary composite endpoint occurred in 14 patients (36%) in the low doses group versus 7 patients (11%) in high dose group (p < 0,01). This difference was particularly observed in the subgroup of patients with ischemic cardiomyopathy. In a multivariable analysis, the higher dose was independently associated with the primary outcome with an HR = 2,934 [IC 95% 1,147 – 7,504]; p = 0,03. Kaplan-Meier curve showed an early effect of the highest dose of sacubitril/valsartan association.
Conclusion: Patients with HFrEF under the highest dose of sacubitril/valsartan showed better clinical outcomes with a decrease of both mortality or appropriated ICD therapies related to ventricular arrhythmias.
I think that Heighpubs very good. You are very helpful. Thank you for everything.
Ana Ribeiro
Archives of Vascular Medicine is one of the top class journal for vascular medicine with highly interesting topics.
You did a professional and great Job!
Elias Noory
I wanna to thank Clinical Journal of Nursing Care and Practice for its effort to review and publish my manuscript. This is reputable journal. Thank you!
Atsedemariam Andualem
The service from the journal staff has been excellent.
Andy Smith
I do appreciate for your service including submission, analysis, review, editorial and publishing process. I believe these esteemed journal enlighten the science with its high-quality personel.
Bora Uysal
The submission is very easy and the time from submission to response from the reviewers is short. Correspondence with the journal is nice and rapid.
Catrin Henriksson
Your service is very good and fast reply, Also your service understand our situation and support us to publication our articles.
Palestine College of Nursing, Khan Younis, Gaza Strip, Palestine
Ayman M Abu Mustafa
Submission of paper was smooth, the review process was fast. I had excellent communication and on time response from the editor.
Ekiti State University Teaching Hospital, Nigeria
Ayokunle Dada
"An amazing experience with the Journal of Advanced Pediatrics and Child Health. Very fast blind review with pertinent corrections and suggestions. I highly recommand both the journal and the editor."
Chaimae Khairoun
The service is nice and the time of processing the application is fast.
Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong
If you are already a member of our network and need to keep track of any developments regarding a question you have already submitted, click "take me to my Query."