scholarly journals Time to switch angiotensin-converting enzyme inhibitors/angiotensin receptor blockers to sacubitril/valsartan in patients with cancer therapy-related cardiac dysfunction

2022 ◽  
Vol 50 (1) ◽  
pp. 030006052110679
Author(s):  
Qianlan Xi ◽  
Zijun Chen ◽  
Tingming Li ◽  
Liya Wang
Keyword(s):  
Heart Failure ◽  
Cancer Therapy ◽  
Cardiac Dysfunction ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Efficacy And Safety ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

Advances in cancer therapy have resulted in more cancer therapy-related cardiac dysfunction (CTRCD), which is the main cause of death in older female survivors of breast cancer. Traditionally, guideline-recommended medications for heart failure, such as beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), are commonly used to prevent or attenuate CTRCD. However, sometimes their effectiveness is not satisfactory. Recently, the drug combination of sacubitril plus valsartan has been proven to be more beneficial for heart failure with reduced ejection fraction in the long term compared with an ACEI/ARB alone. However, there is a lack of evidence of the efficacy and safety of this drug combination in CTRCD. We report a case of worsening CTRCD, despite treatment with traditional medications, in which the patient improved after changing perindopril to sacubitril/valsartan. The patient’s heart function greatly improved after changing this ACEI to sacubitril/valsartan. Changing an ACEI/ARB to sacubitril/valsartan in patients with worsening chemotherapy-induced heart failure is appropriate. Further studies with a high level of evidence are required to assess the efficacy and safety of sacubitril/valsartan for CTRCD.

Abstract 343: Trends and Predictors of Use of Angiotensin Receptor Blocker and Neprilysin Inhibitor in Patients With Heart Failure

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Supriya Shore ◽  
Tanima Basu ◽  
Neil Kamdar ◽  
Patrick Brady ◽  
Scott L Hummel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
Patients With Heart Failure ◽  
Receptor Blockers

Objective: Current guidelines recommend use of combination therapy with angiotensin receptor blocker and neprilysin inhibitor (ARNI) (i.e., Entresto ® ) in patients with heart failure (HF) with reduced ejection fraction as a class 1 recommendation. Contemporary data on real-world use of these agents is lacking. Methods: This is a retrospective cohort study of individuals enrolled in Clinformatics® Data Mart Database (OptumInsight, Eden Prairie, MN from January 1, 2016 to December 31, 2018. We included all individuals ≥ 18 years, with two outpatient encounters or one inpatient encounter with a principal ICD 10 diagnosis for HFand 6 months of continuous enrollment. To further identify patients with reduced ejection fraction, we only included individuals who received prescriptions for beta-blockers and angiotensin converting enzyme inhibitors/ angiotensin receptor blockers. Comorbidities were identified using Elixhauser comorbidity index.. Multivariate logistic regression model was used to identify predictors of ARNI use. Results: A total of 154,777 patients were included in our cohort. Overall, 5,834 patients (3.8%) received an ARNI prescription. Use of ARNI increased from 1.4% in 2016 to 3.9% in 2018 (p<0.01). Compared to patients receiving angiotensin converting enzyme inhibitors/angiotensin receptor blockers, patients receiving ARNI were younger (mean age 69.4 ± 11.1 vs. 72.9 ± 11.0 years;), more likely to be male (69.3% vs. 54.4%) and have commercial insurance (22.1% vs. 16.7%) with a higher comorbidity burden. Predictors of ARNI use after multivariable adjustment included age<65 years (OR 1.4; 95% CI 1.3-1.5), Male sex (OR 1.8; 95% CI 1.7 - 1.9) and black race (OR 1.2; 95% CI 1.1 - 1.2). Other predictors of ARNI use are shown in Figure 1. Patients receiving care through a cardiologist compared to a primary care physician were more likely to receive an ARNI (OR 1.8; 95% 1.7 - 1.9). Out of pocket cost for ARNI ranged from $0 to $1006 per month (median $44; IQR $9-$60). Conclusion: Rates of ARNI use remain low among patients with heart failure with racial and gender disparities. Heart Failure patients receiving care with a cardiologist were more likely to receive ARNI. Out of pocket cost for this medication remains high and may be a significant barrier to its use.

Abstract 19292: The Efficacy of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Coronary Artery Disease and No Heart Failure in the Modern Statin Era: a Meta-Analysis of Randomized-Controlled Trials

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vu Hoang ◽  
Daniel Addison ◽  
Mahboob Alam ◽  
Salim Virani ◽  
Yochai Birnbaum
Keyword(s):  
Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Randomized Controlled ◽  
Receptor Blockers ◽  
Artery Disease

Background: Data from randomized-controlled trials regarding the efficacy of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) in patients with coronary artery disease (CAD) but no evidence of heart failure are inconclusive. Current ACC/AHA guidelines support their use in this population. The variation in efficacy of ACEi and ARBs in improving cardiovascular (CV) outcomes may be related to the rising use of statin therapy in the past two decades. Methods: We conducted literature review of randomized-controlled trials with ACEi or ARBs as the single intervention, focusing on studies involving patients with CAD including patients with left ventricular dysfunction but no clinical symptoms of heart failure. The MEDLINE database was searched for publications between 1/1/1980 and 12/31/2012 with searched terms including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, coronary artery disease, cardiovascular events, and myocardial infarction. Of the 1553 potentially relevant publications, 19 (14 ACEi and 5 ARB) met the inclusion criteria for a total of 99,631 randomized patients followed for a mean of 38 months. We evaluated the endpoints of CV mortality, all-cause mortality, non-fatal MI, and stroke. The relationship between endpoints across the 19 trials and the percentage of patients on statins in each trial (with available data) were evaluated using meta-regression analysis, expressed as highest standardized regression coefficient, Beta. Results: ACEi and ARB therapy across the 19 trials was associated with decreased CV mortality (OR 0.85; 95% CI 0.78-0.93) and all-cause mortality (OR 0.92; 95% CI 0.86-0.98). When adjusted for the percentage of statin, 46% of patients in the cohort, there was a significant linear decrease in the odds of CV mortality reduction with ACEi and ARB therapy (Beta = 0.01; p = 0.034). Conclusion: In patients with CAD and no evidence of heart failure, the additive benefits of ACEi and ARBs in decreasing CV mortality are blunted by statin therapy. The exact mechanism(s) for this result is unclear and further investigation is warranted. The modification of current ACC/AHA practice guidelines should be considered.

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