Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR) [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2021; 49(5): 357-367 | DOI: 10.5543/tkda.2021.63099

Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR)

Berkay Ekici1, Mehmet Yaman2, Murathan Küçük3, Seçkin Dereli4, Mustafa Yenerçağ5, Zerrin Yiğit6, Mehmet Memduh Baş7, Yusuf Karavelioğlu8, Hüseyin Altuğ Çakmak9, Tarık Kıvrak10, Hakan Özkan11, Cihan Altın12, Cengiz Sabanoğlu13, Burcu Demirkan14, Ali Ekber Ataş15, Fethi Kılıçaslan16, Hakan Altay17, İstemihan Tengiz18, Aycan Fahri Erkan1, Barış Kılıçaslan19, Fatih Erkam Olgun20, Murtaza Emre Durakoğlugil21, Aslıhan Alhan22, Mehdi Zoghi23
1Department of Cardiology, Ufuk University School of Medicine, Ankara, Turkey
2Department of Cardiology, Private Echomar Hospital, Zonguldak, Turkey
3Department of Cardiology, Akdeniz University School of Medicine, Antalya, Turkey
4Departmant of Cardiology, Ordu University School of Medicine, Ordu, Turkey
5Department of Cardiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey
6Institute of Cardiology, İstanbul University School of Medicine, İstanbul, Turkey
7Department of Cardiology, Private Meydan Hospital, Şanlıurfa, Turkey
8Department of Cardiology, Hitit University School of Medicine, Çorum, Turkey
9Department of Cardiology, Mustafakemalpaşa State Hospital, Bursa, Turkey
10Department of Cardiology, Fırat University School of Medicine, Elazığ, Turkey
11Department of Cardiology, VM Medical Park Bursa Hospital, Bursa, Turkey
12Department of Cardiology, Başkent University İzmir Zübeyde Hanım Application and Research Center, İzmir, Turkey
13Department of Cardiology, Kırıkkale High Specialization Hospital, Kırıkkale, Turkey
14Department of Cardiology, Ankara City Hospital, Ankara, Turkey
15Department of Cardiology, VM Medical Park Samsun Hospital, Samsun, Turkey
16Department of Cardiology, Bağcılar Medipol Mega University Hospital, İstanbul, Turkey
17Department of Cardiology, Başkent University School of Medicine, İstanbul, Turkey
18Department of Cardiology, Medical Park İzmir Hospital, İzmir, Turkey
19Department of Cardiology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, Samsun, Turkey
20Department of Cardiology, Sefaköy Medipol University Hospital, İstanbul, Turkey
21Department of Cardiology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
22Department of Biostatistics, Ufuk University School of Medicine, Ankara, Turkey
23Department of Cardiology, Ege University School of Medicine, İzmir, Turkey


OBJECTIVE
Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey.

METHODS
The ARNi-TR is a multicenter, noninterventional, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control.

RESULTS
N‐terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypertension (16.9%) was the most common side effect in patients using ARN.

CONCLUSION
The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.

Keywords: Heart failure treatment, sacubitril/valsartan, real-world experiences

How to cite this article
Berkay Ekici, Mehmet Yaman, Murathan Küçük, Seçkin Dereli, Mustafa Yenerçağ, Zerrin Yiğit, Mehmet Memduh Baş, Yusuf Karavelioğlu, Hüseyin Altuğ Çakmak, Tarık Kıvrak, Hakan Özkan, Cihan Altın, Cengiz Sabanoğlu, Burcu Demirkan, Ali Ekber Ataş, Fethi Kılıçaslan, Hakan Altay, İstemihan Tengiz, Aycan Fahri Erkan, Barış Kılıçaslan, Fatih Erkam Olgun, Murtaza Emre Durakoğlugil, Aslıhan Alhan, Mehdi Zoghi. Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). Turk Kardiyol Dern Ars. 2021; 49(5): 357-367

Corresponding Author: Berkay Ekici, Türkiye
© Copyright 2021 Archives of the Turkish Society of Cardiology
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