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Titel: Less loop diuretic use in patients on sacubitril/valsartan undergoing remote pulmonary artery pressure monitoring
VerfasserIn: Böhm, Michael
Assmus, Birgit
Anker, Stefan D.
Asselbergs, Folkert W.
Brachmann, Johannes
Brett, Marie-Elena
Brugts, Jasper J.
Ertl, Georg
Wang, AiJia
Hilker, Lutz
Koehler, Friedrich
Rosenkranz, Stephan
Leistner, David M.
Abdin, Amr
Wintrich, Jan
Zhou, Qian
Adamson, Philip B.
Angermann, Christiane E.
Sprache: Englisch
Titel: ESC Heart Failure
Bandnummer: 9
Heft: 1
Seiten: 155–163
Verlag/Plattform: Wiley
Erscheinungsjahr: 2021
Freie Schlagwörter: Drug therapy
Loop diuretics
Heart failure
Pulmonary artery pressure
Monitor
DDC-Sachgruppe: 610 Medizin, Gesundheit
Dokumenttyp: Journalartikel / Zeitschriftenartikel
Abstract: Aims Control of pulmonary pressures monitored remotely reduced heart failure hospitalizations mainly by lowering filling pressures through the use of loop diuretics. Sacubitril/valsartan improves heart failure outcomes and increases the kidney sensitivity for diuretics. We explored whether sacubitril/valsartan is associated with less utilization of loop diuretics in patients guided with haemodynamic monitoring in the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF). Methods and results The MEMS-HF population (n = 239) was separated by the use of sacubitril/valsartan (n = 68) or no use of it (n = 164). Utilization of diuretics and their doses was prespecified in the protocol and was monitored in both groups. Multivariable regression, ANCOVA, and a generalized linear model were used to fit baseline covariates with furosemide equivalents and changes for 12 months. MEMS-HF participants (n = 239) were grouped in sacubitril/valsartan users [n = 68, 64 ± 11 years, left ventricular ejection fraction (LVEF) 25 ± 9%, cardiac index (CI) 1.89 ± 0.4 L/min/m2] vs. non-users (n = 164, 70 ± 10 years, LVEF 36 ± 16%, CI 2.11 ± 0.58 L/min/m2, P = 0.0002, P < 0.0001, and P = 0.0015, respectively). In contrast, mean pulmonary artery pressure (PAP) values were comparable between groups (29 ± 11 vs. 31 ± 11 mmHg, P = 0.127). Utilization of loop diuretics was lower in patients taking sacubitril/valsartan compared with those without (P = 0.01). Significant predictor of loop diuretic use was a history of renal failure (P = 0.005) but not age (P = 0.091). After subjects were stratified by sacubitril/valsartan or other diuretic use, PAP was nominally, but not significantly lower in sacubitril/valsartan-treated patients (baseline: P = 0.52; 6 months: P = 0.07; 12 months: P = 0.53), while there was no difference in outcome or PAP changes. This difference was observed despite lower CI (P = 0.0015). Comparable changes were not observed for other non-loop diuretics (P = 0.21). Conclusions In patients whose treatment was guided by remote PAP monitoring, concomitant use of sacubitril/valsartan was associated with reduced utilization of loop diuretics, which could potentially be relevant for outcomes.
DOI der Erstveröffentlichung: 10.1002/ehf2.13665
Link zu diesem Datensatz: urn:nbn:de:bsz:291--ds-358968
hdl:20.500.11880/32716
http://dx.doi.org/10.22028/D291-35896
ISSN: 2055-5822
Datum des Eintrags: 4-Apr-2022
Bezeichnung des in Beziehung stehenden Objekts: Supporting Information
In Beziehung stehendes Objekt: https://onlinelibrary.wiley.com/action/downloadSupplement?doi=10.1002%2Fehf2.13665&file=ehf213665-sup-0001-Suppl.Figure.pdf
Fakultät: M - Medizinische Fakultät
Fachrichtung: M - Innere Medizin
Professur: M - Prof. Dr. Michael Böhm
Sammlung:SciDok - Der Wissenschaftsserver der Universität des Saarlandes



Diese Ressource wurde unter folgender Copyright-Bestimmung veröffentlicht: Lizenz von Creative Commons Creative Commons