Horiuchi Yu, Asami Masahiko, Yahagi Kazuyuki, Oshima Asahi, Gonda Yuki, Yoshiura Daiki, Komiyama Kota, Yuzawa Hitomi, Tanaka Jun, Aoki Jiro, Tanabe Kengo
Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumicho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan.
Heart Vessels. 2025 Mar;40(3):227-234. doi: 10.1007/s00380-024-02459-6. Epub 2024 Oct 5.
The global use of angiotensin receptor neprilysin inhibitor (ARNI) in clinical practice, especially in patients with heart failure and below-normal ejection fraction (HFbnEF), has not been thoroughly evaluated. We aimed to investigate the characteristics, outcomes, and adverse events in patients treated with ARNI for HF with reduced (HFrEF), below-normal (HFbnEF), and supranormal left ventricular EF (HFsnEF).
This observational study analyzed data from the electronic healthcare records (EHR) of patients with HF treated with ARNI between 2015 and 2022 in North and South America, Europe, the Middle East, Africa, and Asia-Pacific. Based on the left ventricular EF, patients were categorized as HFrEF (< 40%), HFbnEF (40-60%), and HFsnEF (> 60%). Mortality and the incidence of adverse events were investigated.
Of the 11,141 patients analyzed, HFrEF, HFbnEF and HFsnEF accounted for 74%, 22%, and 4%, respectively. Patients with a higher EF were more likely to be older, female, and obese. Hypertension and atrial fibrillation were the most common in HFsnEF. Systolic blood pressure was lower and natriuretic peptide levels were higher in the lower EF groups. Mortality was lowest in HFbnEF (7.7 per 100 patient-years follow-up in HFrEF, 5.8 in HFmrEF, and 6.0 in HFsnEF). Similarly, hypotension and acute kidney injury were the least frequent in HFbnEF. Incidence of elevated serum potassium levels was similar between the groups.
In this analysis of large-scale EHR, ARNI was mainly used in HFrEF and HFbnEF, consistent with previous randomized trials and pooled analyses. Adverse events were less common in HFbnEF.
血管紧张素受体脑啡肽酶抑制剂（ARNI）在临床实践中的全球使用情况，尤其是在射血分数低于正常水平的心力衰竭（HFbnEF）患者中，尚未得到充分评估。我们旨在研究接受ARNI治疗的射血分数降低（HFrEF）、低于正常水平（HFbnEF）和超常左心室射血分数（HFsnEF）的心力衰竭患者的特征、结局和不良事件。
这项观察性研究分析了2015年至2022年期间在北美、南美、欧洲、中东、非洲和亚太地区接受ARNI治疗的心力衰竭患者的电子健康记录（EHR）数据。根据左心室射血分数，患者被分为HFrEF（<40%）、HFbnEF（40-60%）和HFsnEF（>60%）。调查了死亡率和不良事件的发生率。
在分析的11141例患者中，HFrEF、HFbnEF和HFsnEF分别占74%﹑22%和4%。射血分数较高的患者更可能年龄较大、为女性且肥胖。高血压和心房颤动在HFsnEF中最为常见。较低射血分数组的收缩压较低，利钠肽水平较高。HFbnEF组的死亡率最低（HFrEF每100患者年随访中有7.7例死亡，HFmrEF中有5.8例，HFsnEF中有6.0例）。同样，HFbnEF中低血压和急性肾损伤的发生率最低。各组间血清钾水平升高的发生率相似。
在这项大规模EHR分析中，ARNI主要用于HFrEF和HFbnEF，这与先前的随机试验和汇总分析一致。HFbnEF中的不良事件较少见。
