Minerva Cardiology and Angiology 2021 Apr 07

DOI: 10.23736/S2724-5683.20.05494-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Trend of perceived quality of life and functional capacity in outpatients with chronic heart failure and in treatment with sacubitril/valsartan: a real-life experience

Giuseppe DATTILO ¹, Roberto BITTO ¹, Michele CORREALE ² ✉, Claudia MORABITO ¹, Vittoria VACCARO ¹, Giulia LATERRA ¹, Matteo CASALE ¹, Pasquale CREA ¹, Gianluca DI BELLA ¹, Francesco LUZZA ¹, Alessandro MIGLIORATO ¹, Niki KATSIKI ³, Cesare DE GREGORIO ¹

¹ Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; ² Cardiology Unit, Policlinico Riuniti University Hospital, Foggia, Italy; ³ Second Department of Propaedeutic Internal Medicine, Medical School, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

BACKGROUND: Despite the use of optimal medical therapy, HFrEF remains a leading cause of morbidity, mortality and health care costs. The introduction of angiotensin receptor/neprilysin inhibitors (ARNIs) had a revolutionary impact on the treatment of patients with heart failure and reduced left ventricular ejection fraction (HFrEF).
METHODS: The aim of the study was to monitor over time the perceived quality of life, the physical performance, the trend of BNP and NT-ProBNP and the NYHA functional class in patients with HFrEF during treatment with sacubitril/valsartan. We enrolled 37 patients (63 ± 10 years old, 76% men) who underwent a total of one year follow-up. All patients underwent clinical evaluation, 6MWT, blood analysis (in particular NT-pro-BNP and BNP, renal function test); Kansas City Cardiomyopathy Questionnaire (KCCQ) and the NYHA functional class assessment were also performed, at the beginning of the study and after 3, 6 and 12 months of therapy.
RESULTS: We observed at each follow-up a significant improvement of KCCQ score, 6MWT, NTProBNP, BNP and of NYHA class. However, analyzing the Δ % of variation of each single parameter, the improvement was not uniform in time. We also observed that only 37% of patients tolerated the full recommended dose of sacubitril/valsartan (97/103 mg b.i.d.); of the remaining, 40% tolerated the intermediate dose (49/51 mg b.i.d.) and 23% the minimum (24/26 md b.i.d.).
CONCLUSIONS: Sacubitril/valsartan therapy improves significantly quality of life, physical effort resistance, BNP and NT-ProBNP and NYHA functional class in patients with HFrEF. Although not all the patients tolerated the maximum recommended dose, the beneficial effects were significant even at lower doses.

KEY WORDS: Heart failure with reduced ejection fraction; Sacubitril/Valsartan; Kansas City cardiomyopathy questionnaire; 6-minutes walking test; Natriuretic peptides