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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沙比利/缬沙坦对心力衰竭患者房颤负担的影响：一项回顾性观察研究

Sacubitril/缬沙坦（一种血管紧张素受体-neprilysin抑制剂[ARNI]）可能改善心房颤动（AF）病情，但其附加价值仍存在争议。目的分析ARNI对房颤负担的影响。方法在某三级医学中心进行单中心、回顾性自我对照研究。数据检索时间为2019年1月至2023年1月。所有心脏再同步治疗-植入式心律转复除颤器（CRT-D）的ARNI携带者，如果在药物开始前植入式心律转复除颤器至少3个月被纳入研究。定义心律失常事件、等时间长度控制（ARNI开始前）和暴露（ARNI开始后）周期。如果他们在ARNI开始前1岁，如果他们在开始后3个月至1年可用，则检索超声心动图数据。通过发作事件的频率和中位数来定义房颤负担，并确定房颤状态的总体变化。该研究得到了Universitário科英布拉医院中心伦理委员会的伦理批准（参考编号：PI OBS.SF.174-2022），该研究符合赫尔辛基宣言。结果共纳入72例患者，男性占73.3%。ARNI后，纽约心脏协会功能分级±标准差（2.00±0.75）降低至1.85±0.61,p = 0.043)，左室射血分数±标准差（31.67%±9.28% vs 37.33%±14.49%,p = 0.027）增加。ARNI开始前，34例患者无房颤，19例为阵发性房颤，15例为永久性房颤，2例为持续性房颤。ARNI开始后，房颤总发作次数（91次vs 44次，p = 0.808）和中位发作次数（阵发性房颤或无房颤）（5次vs 3次，p = 0.121）均有所减少，但差异无统计学意义。在室性心律失常或器械治疗方面也没有发现差异。结论ARNI未显著降低AF发作次数或每位患者发作次数的中位数。尽管ARNI可能对心力衰竭患者的心房颤动负担有积极影响，但需要更大规模的研究来提供明确的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.