Medication strategy of angiotensin receptor neprilysin inhibitor sacubitril valsartan in elderly patients with heart failure with reduced ejection fraction
Objective To explore the medication strategy of angiotensin receptor neprilysin inhibitor(ARNI)sacubitril valsartan in elderly patients with heart failure with reduced ejection fraction(HFrEF).Methods A total of 168 elderly patients with HFrEF who were treated with ARNI in our hospital from October 2019 to October 2021 were selected as the study subjects.The patient data and echocardiographic indicators were collected,the dose changes of ARNI sacubitril valsartan and its influencing factors were analyzed.Results Among 168 elderly patients with HFrEF,the initial dose≤50 mg bid accounted for a large proportion(71.43%);after 6 months of follow-up,8 cases(4.76%)were titrated to the target dose,137 cases(81.55%)were lower than the target dose,and 23 cases(13.69%)were withdrawal.Multivariate Logistic regression analysis showed that rehospitalization was an influencing factor for the increase of sacubitril valsartan dose in elderly patients with HFrEF(P<0.05);drug side effects and poor implementation of medical orders were the influencing factors of dose reduction or withdrawal of sacubitril valsartan in elderly patients with HFrEF(P<0.05).After 6 months of follow-up,the New York Heart Association(NYHA)cardiac function classification of the patients was better than that before treatment,the left ventricular ejection fraction(LVEF)and cardiac index(CI)were higher than those before treatment,and the left ventricular end-diastolic diameter(LVEDD)was lower than that before treatment(P<0.01).Conclusion The dose of most elderly HFrEF patients treated with ARNI sacubitril valsartan is maintained below the target dose level.Rehospitalization,drug side effects and poor implementation of medical orders are related factors affecting titration changes.
heart failure with reduced ejection fractionelderlysacubitril valsartanangiotensin receptor
NETL
NSTL
维普
万方数据
