Uptitration of Sacubitril/Valsartan and Outcomes in Patients With Heart Failure　― Insight From the REVIEW-HF Registry ―

作者：Shunichi Doi, Keisuke Kida, Takahito Nasu, Shunsuke Ishii, Nobuyuki Kagiyama, Wataru Fujimoto, Atsushi Kikuchi, Takeshi Ijichi, Tatsuhiro Shibata, Koshiro Kanaoka, Shingo Matsumoto, Yoshihiro J. Akashi · 发表于：Circulation Journal · 年份：2024 · DOI：10.1253/circj.cj-24-0636 · 被引用次数：11 · 研究领域：Heart Failure Treatment and Management、Cardiovascular Function and Risk Factors、Cardiac pacing and defibrillation studies

BACKGROUND: Guideline-directed medical therapy has become an important component of heart failure (HF) therapy, with sacubitril/valsartan as one of the recommended drugs; however, the real-world prognostic implications of sacubitril/valsartan uptitration are unclear. METHODS AND RESULTS: Patients with HF newly initiated on sacubitril/valsartan were registered in a retrospective multicenter study (REVIEW-HF). In all, 995 patients were divided into 3 groups according to the maximum dose achieved: high dose, sacubitril/valsartan 400 mg; intermediate dose, sacubitril/valsartan 200-<400 mg; and low dose, sacubitril/valsartan <200 mg. A total of 397 (39.9%) patients received high-dose sacubitril/valsartan; they had a significantly lower risk of mortality or HF hospitalization than patients in the low-dose (hazard ratio [HR] 0.39; 95% confidence interval [CI] 0.29-0.53; P<0.001) and intermediate-dose (HR 0.64; 95% CI 0.45-0.94; P=0.03) groups. In the multivariable Cox regression model, higher systolic blood pressure and maintained geriatric nutritional risk index were significantly associated with a higher incidence of achieving a high dose of sacubitril/valsartan. Patients who did not receive high-dose sacubitril/valsartan experienced more hypotension during the follow-up period, whereas hyperkalemia, severe renal events, and angioedema did not differ across the achieved dose classifications. CONCLUSIONS: Patients who achieved sacubitril/valsartan uptitration had a better prognosis...