Iwasaki Erika, Kohyama Noriko, Inamoto Mayumi, Nagao Michiru, Sunaga Tomiko, Suzuki Hiroshi, Ebato Mio, Kogo Mari
Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, Tokyo, Japan.
Department of Pharmacy, Showa University Fujigaoka Hospital, Kanagawa, Japan.
Ann Pharmacother. 2025 Apr;59(4):301-310. doi: 10.1177/10600280241277354. Epub 2024 Sep 4.
Sacubitril/valsartan (SV) is recommended for patients with heart failure (HF). In addition, a combination of 4 HF medications, including SV, is recommended in patients with HF with reduced ejection fraction (HFrEF). However, evidence on the characteristics of patients who could continue SV and its initiation methods is limited.
To investigate the factors associated with SV continuation and methods of combining HF medications.
This retrospective cohort study included HF patients who initiated with SV at our institution. The endpoint was SV continuation for 6 months after its initiation. Multivariate analysis was used to extract factors associated with SV continuation. The relationship between the methods of combining HF medications (renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or sodium-glucose cotransporter 2 inhibitors), including the number of HF medications, their combination patterns, and the timing of their initiation, and SV continuation was examined in patients with HFrEF.
Of 186 eligible patients, 68.8% had HFrEF, and 79.0% continued SV for 6 months. Significant factors associated with SV continuation were albumin ≥ 3.5 g/dL (odds ratio, 4.81; 95% confidence interval, 2.19-10.59), body mass index (BMI) ≥ 18.5 kg/m (4.17; 1.10-15.85), and systolic blood pressure (SBP) ≥ 110 mmHg (2.66; 1.12-6.28). In patients with HFrEF, the proportion of HF medications not initiated simultaneously with SV was significantly higher in the continuation group than in the discontinuation group (67.3% vs 33.3%, = 0.002). The number of HF medications and their combination patterns were not significantly associated with SV continuation.
Albumin, BMI, and SBP are useful indicators for selecting patients who are likely to continue SV. In addition, initiating only SV without simultaneously initiating other HF medications in patients with HFrEF may lead to SV continuation.
沙库巴曲缬沙坦（SV）被推荐用于心力衰竭（HF）患者。此外，对于射血分数降低的心力衰竭（HFrEF）患者，推荐使用包括SV在内的4种心力衰竭药物联合治疗。然而，关于能够继续使用SV的患者特征及其起始方法的证据有限。
研究与SV继续使用相关的因素以及心力衰竭药物联合使用的方法。
这项回顾性队列研究纳入了在我们机构起始使用SV的心力衰竭患者。终点是起始使用SV后持续使用6个月。采用多变量分析来提取与SV继续使用相关的因素。在HFrEF患者中，研究了心力衰竭药物联合使用的方法（肾素 - 血管紧张素系统抑制剂、β受体阻滞剂、盐皮质激素受体拮抗剂或钠 - 葡萄糖协同转运蛋白2抑制剂），包括心力衰竭药物的数量、联合使用模式及其起始时间与SV继续使用之间的关系。
186例符合条件的患者中，68.8%为HFrEF，79.0%的患者持续使用SV达6个月。与SV继续使用相关的显著因素为白蛋白≥3.5 g/dL（比值比，4.81；95%置信区间，2.19 - 10.59）、体重指数（BMI）≥18.5 kg/m²（4.17；1.10 - 15.85）和收缩压（SBP）≥110 mmHg（2.66；1.12 - 6.28）。在HFrEF患者中，继续使用组未与SV同时起始使用的心力衰竭药物比例显著高于停药组（67.3%对33.3%，P = 0.002）。心力衰竭药物的数量及其联合使用模式与SV继续使用无显著相关性。
白蛋白、BMI和SBP是选择可能继续使用SV患者的有用指标。此外，在HFrEF患者中仅起始使用SV而不同时起始其他心力衰竭药物可能会使患者继续使用SV。
