Impact of sacubitril/valsartan on atrial fibrillation burden in heart failure: a retrospective observational study

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2024-10-04 DOI:10.1002/jppr.1942

Ana Barradas MD, Diogo de Almeida Fernandes MD, Inês Fonseca BHSc, Natália António MD, PhD, Luís Elvas MD, Lino Gonçalves MD, PhD

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引用次数: 0

Abstract

Background

Sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitors [ARNI]) might improve atrial fibrillation (AF) condition, but its added value remains controversial.

Aim

We aimed to analyse the effect of ARNI on AF burden.

Method

We conducted a single-centre, retrospective self-controlled study in a tertiary centre. Data were retrieved from January 2019–January 2023. All cardiac resynchronisation therapy-implantable cardioverter defibrillator (CRT-D) carriers on ARNI were included if implantation had been at least 3 months before drug initiation. Proarrhythmic events, equal time length control (before ARNI initiation), and exposure (after ARNI initiation) periods were defined. Echocardiographic data were retrieved if they were up to 1 year old before ARNI initiation and if they were available 3 months to 1 year after initiation. AF burden was defined by frequency and median value of paroxysmal events and the overall variation in AF status was determined. Ethical approval was granted by the Ethics Committee of the Centro Hospitalar e Universitário de Coimbra (Reference no: PI OBS.SF.174-2022) and the study conforms with the Declaration of Helsinki.

Results

Seventy-two patients were included in the study (73.3% men). After ARNI, there was a reduction in New York Heart Association functional class ± standard deviation (2.00 ± 0.75 to 1.85 ± 0.61, p = 0.043) and an increase in left ventricular ejection fraction ± standard deviation (from 31.67% ± 9.28% vs 37.33% ± 14.49%, p = 0.027). Before ARNI initiation, 34 patients did not have AF, 19 had paroxysmal AF, 15 had permanent AF, and 2 had persistent AF. The total amount of AF episodes (91 vs 44, p = 0.808) and median paroxysmal episodes (among those with paroxysmal AF or no AF) (5 vs 3, p = 0.121) were numerically reduced after ARNI initiation, though variation was not statistically significant. No differences were found as well regarding ventricular arrhythmias or device therapies.

Conclusion

ARNI did not significantly decrease the number of AF paroxysmal episodes or median number of paroxysmal events per patient. Even though ARNI may have a positive impact on AF burden of heart failure patients, larger studies are needed to provide unequivocal evidence.

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.