| 摘要: | Heart failure (HF) is an increasingly prevalent medical condition worldwide, placing a considerable burden on the global healthcare system. About 10 percent of people over the age of 70 suffer from HF. The prevalence rate of HF in developed countries is about 1-2%. In Taiwan, 6% of the population over the age of 40 develop HF every year, and it is estimated that there are about 500,000 patients. Approximately one-third of patients with chronic HF will also have comorbid chronic kidney disease (CKD), which increases the mortality and hospitalization rates of these patients.
Aim
Therapeutic effects of sacubitril/valsartan for patients with heart HF are evident but HF patients with advanced CKD lack evaluation. Long-term outcomes of HF patients with coexisting ESRD treated with sacubitril/valsartan remain unclear. This study aimed to evaluate the effects of sacubitril/valsartan on long-term survival of patients with heart failure with reduced ejection fraction (HFrEF) and coexisting ESRD on dialysis.
Methods
This retrospective cohort study analyzed treatment efficacy of sacubitril/valsartan in patients with HFrEF and coexisting ESRD compared to using valsartan or candesartan. In total, 2860 patients diagnosed with HFrEF and ESRD between January 1, 2008 and December 31, 2020 were included. After propensity score matching, data of a sacubitril/valsartan group (n = 61) and a candesartan or valsartan group (n = 117) were analyzed.
In patients receiving sacubitril/valsartan for at least nine months total treatment duration, 24 of 61 patients (39.3%) died, and 64 of 117 patients (54.7%) receiving non-sacubitril/valsartan died. Incidence rates of all-cause five-year mortality in matched sacubitril/valsartan and non- sacubitril/valsartan were 1.19 and 1.98, respectively (hazard ratio [HR], 0.46; 95% CI, 0.25-0.82; p=0.0094). Baseline left ventricular ejection fraction (LVEF) in patients receiving sacubitril/valsartan for at least three years was 38.06+-13.47%, compared to 47.00+-13.95% in the matched group (p=0.001). LVEF after three years in sacubitril/valsartan group and non-sacubitril/valsartan group were 52.57+-16.76 and 53.91+-14.89, respectively (p=0.666). LVEF improvement after three years in sacubitril/valsartan was 14.51+-18.98, and 6.91+-18.44 in non-sacubitril/valsartan group (p=0.0408). Average hospitalizations in sacubitril/valsartan and non-sacubitril/valsartan groups were 1.39 and 0.97, respectively (incidence rate ratio, 1.59; 95% CI, 0.90-2.82; p=0.1106).
Conclusion
In patients with HFrEF and coexisting ESRD, five-year mortality rates are significantly lower in patients treated with sacubitril/valsartan than in those receiving candesartan or valsartan. Although LVEF improvement is noted in both groups, improvement is greater in the sacubitril/valsartan group while baseline LVEF was much worse. |
