Impact of Sacubitril/ Valsartan on quality of life and ejection fraction of heart failure patients with and without chronic kidney disease

TL;DR

This study shows that sacubitril/valsartan improves quality of life and slightly increases ejection fraction in heart failure patients, both with and without chronic kidney disease.

Contribution

Demonstrates the effectiveness of sacubitril/valsartan in improving quality of life and ejection fraction in heart failure patients with and without CKD.

Findings

Quality of life improved significantly in both CKD and non-CKD heart failure patients after 12 months of sacubitril/valsartan treatment.

Ejection fraction increased slightly in both CKD and non-CKD patients, though the improvement was modest.

Quality of life is a useful measure to assess treatment benefits, independent of ejection fraction changes.

Abstract

Chronic kidney disease (CKD) patients are at high risk of heart failure (HF) and both share similar risk factors, including diabetes and elevated blood Pressure (B.P). Aim of this study was to determine the impact of sacubitril/valsartan on the quality of life (QOL) and ejection fraction (EF) of patients with HF with and without CKD.

Single center (Doctors Hospital Lahore), observational study with longitudinal follow up, on 104 HF patients from July 2019 to July 2020. HF was diagnosed on both clinical and echo parameters. New York Heart Association Class II-IV, EF less than or equal to 40% HF with reduced EF and stage three CKD patients were included. Sacubitril/Valsartan was prescribed at a starting daily dose of 50mg and then up titrated to 400mg. Patients were followed up with clinical evaluation, QOL assessment, echocardiography and biochemical profile at one, four, eight and 12 months.

Gender, age, and diabetes mellitus between CKD and non-CKD patients were noted to be statistically different, defined as p<0.05. CKD patients’ QOL increased from 45.15 to 57.57 from baseline to 12 months (p-value<0.01). Non-CKD patients’ QOL increased from 48.07 to 56.25. In CKD patients, EF increased from 27.87% to 29.29% from baseline to 12 months (p-value 0.03) whereas in non-CKD patients EF improved from 29.42% to 31.43%.

Sacubitril/ valsartan improves QOL in patients of HF with reduced EF both with and without CKD. Clinical improvement was independent of Left Ventricular EF as measured by QOL. Thus, QOL is a useful tool to assess the drug’s beneficial effect.

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