Universität zu Köln

Boehm, Michael, Assmus, Birgit, Anker, Stefan D., Asselbergs, Folkert W. ORCID: 0000-0002-1692-8669, 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. and Angermann, Christiane E. (2022). Less loop diuretic use in patients on sacubitril/valsartan undergoing remote pulmonary artery pressure monitoring. ESC Heart Fail., 9 (1). S. 155 - 164. SAN FRANCISCO: WILEY PERIODICALS, INC. ISSN 2055-5822

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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/m(2)] vs. non users (n = 164, 70 +/- 10 years, LVEF 36 +/- 16%, CI 2.11 +/- 0.58 l/min/m(2), 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Boehm, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Assmus, Birgit UNSPECIFIED UNSPECIFIED UNSPECIFIED Anker, Stefan D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Asselbergs, Folkert W. UNSPECIFIED orcid.org/0000-0002-1692-8669 UNSPECIFIED Brachmann, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Brett, Marie-Elena UNSPECIFIED UNSPECIFIED UNSPECIFIED Brugts, Jasper J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ertl, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Wang, AiJia UNSPECIFIED UNSPECIFIED UNSPECIFIED Hilker, Lutz UNSPECIFIED UNSPECIFIED UNSPECIFIED Koehler, Friedrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosenkranz, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Leistner, David M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Abdin, Amr UNSPECIFIED UNSPECIFIED UNSPECIFIED Wintrich, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Zhou, Qian UNSPECIFIED UNSPECIFIED UNSPECIFIED Adamson, Philip B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Angermann, Christiane E. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-603567
DOI:	10.1002/ehf2.13665
Journal or Publication Title:	ESC Heart Fail.
Volume:	9
Number:	1
Page Range:	S. 155 - 164
Date:	2022
Publisher:	WILEY PERIODICALS, INC
Place of Publication:	SAN FRANCISCO
ISSN:	2055-5822
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PROGRESSIVE HEART-FAILURE; NATRIURETIC-PEPTIDE; DEATH; HOSPITALIZATIONS; ENALAPRIL; MORTALITY; IMPACT; TRIAL Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/60356