Laflamme Émilie, Vachon Audrey, Gilbert Sylvain, Boisvert Julie, Leclerc Vincent, Bernier Mathieu, Voisine Pierre, Sénéchal Mario, Bergeron Sébastien
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada. Email:
Cardiovasc J Afr. 2018;29(6):352-356. doi: 10.5830/CVJA-2018-039. Epub 2018 Aug 28.
A reduction in the rate of death and hospitalisations in patients with heart failure (HF) with reduced ejection fraction receiving sacubitril/valsartan compared to enalapril was demonstrated in the PARADIGM-HF study. However, tolerability when initiating and optimising sacubitril/valsartan treatment in real clinical practice is unknown.
We performed a prospective cohort study of clinical and biochemical parameters of the first 100 patients receiving sacubitril/valsartan in a tertiary HF clinic. Patients had titration of the molecule guided by an algorithm developed by pharmacists and cardiologists in the clinic. The objective was to evaluate the proportion of patients reaching the maximal dosage, the time to reach maximal dosage, and the rate of adverse events, as well as the required modification of other HF therapy during the sacubitril/valsartan titration.
Forty-six per cent of patients reached the sacubitril/valsartan maximal dose of 97/103 mg (200 mg) twice daily and 73% received at least 49/51 mg (100 mg) twice daily. Mean titration time was 30 ± 9 days. Symptomatic hypotension, renal dysfunction (increase in creatinine level > 30%) and hyperkalaemia (potassium level > 5.5 mmol/l) occurred in nine, four and 2% of patients, respectively. Background HF pharmacological treatment remained stable during the sacubitril/valsartan titration but daily dosage of furosemide was reduced by 13% ( = 0.0005).
This algorithm is a safe and easy-to-use tool in daily clinical practice for the introduction and titration of sacubitril/valsartan. Almost half of the patients reached the maximal dose, with a tolerability profile in line with the original study.
PARADIGM-HF研究表明，与依那普利相比，射血分数降低的心力衰竭（HF）患者接受沙库巴曲缬沙坦治疗后，死亡率和住院率有所降低。然而，在实际临床实践中启动和优化沙库巴曲缬沙坦治疗时的耐受性尚不清楚。
我们对一家三级HF诊所中首批接受沙库巴曲缬沙坦治疗的100例患者的临床和生化参数进行了一项前瞻性队列研究。患者在诊所药剂师和心脏病专家开发的算法指导下进行药物滴定。目的是评估达到最大剂量的患者比例、达到最大剂量的时间、不良事件发生率，以及在沙库巴曲缬沙坦滴定期间其他HF治疗所需的调整。
46%的患者达到了沙库巴曲缬沙坦每日两次97/103 mg（200 mg）的最大剂量，73%的患者至少接受了每日两次49/51 mg（100 mg）的剂量。平均滴定时间为30±9天。分别有9%、4%和2%的患者出现症状性低血压、肾功能不全（肌酐水平升高>30%）和高钾血症（钾水平>5.5 mmol/L）。在沙库巴曲缬沙坦滴定期间，HF背景药物治疗保持稳定，但呋塞米的每日剂量减少了13%（P = 0.0005）。
该算法是日常临床实践中引入和滴定沙库巴曲缬沙坦的一种安全且易于使用的工具。几乎一半的患者达到了最大剂量，耐受性与原研究一致。
