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

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). Hypotension (16.9%) was the most common side effect in patients using ARNi. 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.

Anahtar Kelime:

Azalmış ejeksiyon fraksiyonu olan kalp yetersizliği hastalarında anjiyotensin reseptörü neprilysin inhibitörü: Türkiye’den gerçek dünya deneyimi (ARNi-TR)

Öz:

Amaç: Kalp yetersizliği (KY), yüksek morbidite ve mortalite ile birlikte büyüyen bir halk sağlığı sorunudur. Son zamanlarda, anjiyotensin-reseptör neprilisin-inhibitörü (ARNi), düşük ejeksiyon-fraksiyonlu KY (DEFKY) tedavisi için bir umut olarak ortaya çıkmıştır. Bu çalışmada, Türkiye’deki birçok merkezden DEFKY’de ARNi kullanımı ile ilgili deneyimimizi paylaşmayı amaçladık. Yöntemler: ARNi-TR, çok merkezli, girişimsel olmayan, retrospektif, gözlemsel bir çalışmadır. Türkiye’nin çeşitli coğraf bölgelerindeki 22 merkezde, sakubitril/valsartan verilen 779 KY hastası incelendi. Başlangıç klinik durumları, biyokimyasal ve ekokardiyografik parametreler ve New York Kalp Cemiyeti fonksiyonel sınıf (NYHA-FS) değerleri 1 yıllık ARNi kullanımından sonraki takip değerleri ile karşılaştırıldı. ARNi’nin yıllık hastanede yatış sayısına etkisi de araştırıldı. Hastalar ayrıca ARNi’nin hastanede veya poliklinik kontrolünde başlanmasına bağlı olarak iki grupta analiz edildi. Bulgular: 1 yıllık takip süresi boyunca, serum N-terminal pro-beyin natriüretik peptid (NT-proBNP), sol-ventrikül ejeksiyon-fraksiyonu (SV-EF) ve NYHA-FS değerleri her iki grupta da anlamlı düzeldi (tüm parametrelerde, p<0.001). Ayrıca ARNi tedavisi ile iki grupta da hemoglobin A1c (HbA1c) değerlerinde hafif bir düşüş gözlendi (p<0.001). Her iki grupta da ARNi kullanımından sonra günlük diüretik dozlarında ve KY’ye bağlı hastaneye yatışlarda azalma gözlendi (tüm karşılaştırmalarda, p<0.001).Tüm hastalarda ARNi’ye bağlı en sık görülen yan etki hipotansiyondu (%16.9). Sonuç: ARNi-TR çalışması, Türkiye’de ARNi kullanan hastalar için kapsamlı gerçek hayat verileri sunmaktadır. ARNi kullanımı ile FS, NT-proBNP, HbA1c seviyeleri ve SV-EF’de önemli iyileşmeler olmuştur. Benzer şekilde, bu çalışmada KY için yıllık hastaneye yatış sayısında ve günlük furosemid dozlarında önemli düşüşler görülmüştür.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Ekici B, yaman m, kucuk M, Dereli S, Yenerçağ M, Yigit Z, Baş M, KARAVELIOGLU Y, Cakmak H, KIVRAK t, ozkan h, ALTIN C, Sabanoglu C, Demirkan B, Atas A, KILICASLAN F, Altay H, Tengiz I, Erkan A, Kılıçaslan B, OLGUN F, Durakoglugil M, Alhan A, Zoghi M (2021). Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). , 357 - 367. 10.5543/tkda.2021.63099
Chicago	Ekici Berkay,yaman mehmet,kucuk Murathan,Dereli Seçkin,Yenerçağ Mustafa,Yigit Zerrin,Baş Mehmet Memduh,KARAVELIOGLU YUSUF,Cakmak Huseyin Altug,KIVRAK tarik,ozkan hakan,ALTIN Cihan,Sabanoglu Cengiz,Demirkan Burcu,Atas Ali Ekber,KILICASLAN FETHI,Altay Hakan,Tengiz Istemihan,Erkan Aycan Fahri,Kılıçaslan Barış,OLGUN FATIH ERKAM,Durakoglugil Murtaza Emre,Alhan Aslihan,Zoghi Mehdi Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). (2021): 357 - 367. 10.5543/tkda.2021.63099
MLA	Ekici Berkay,yaman mehmet,kucuk Murathan,Dereli Seçkin,Yenerçağ Mustafa,Yigit Zerrin,Baş Mehmet Memduh,KARAVELIOGLU YUSUF,Cakmak Huseyin Altug,KIVRAK tarik,ozkan hakan,ALTIN Cihan,Sabanoglu Cengiz,Demirkan Burcu,Atas Ali Ekber,KILICASLAN FETHI,Altay Hakan,Tengiz Istemihan,Erkan Aycan Fahri,Kılıçaslan Barış,OLGUN FATIH ERKAM,Durakoglugil Murtaza Emre,Alhan Aslihan,Zoghi Mehdi Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). , 2021, ss.357 - 367. 10.5543/tkda.2021.63099
AMA	Ekici B,yaman m,kucuk M,Dereli S,Yenerçağ M,Yigit Z,Baş M,KARAVELIOGLU Y,Cakmak H,KIVRAK t,ozkan h,ALTIN C,Sabanoglu C,Demirkan B,Atas A,KILICASLAN F,Altay H,Tengiz I,Erkan A,Kılıçaslan B,OLGUN F,Durakoglugil M,Alhan A,Zoghi M Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). . 2021; 357 - 367. 10.5543/tkda.2021.63099
Vancouver	Ekici B,yaman m,kucuk M,Dereli S,Yenerçağ M,Yigit Z,Baş M,KARAVELIOGLU Y,Cakmak H,KIVRAK t,ozkan h,ALTIN C,Sabanoglu C,Demirkan B,Atas A,KILICASLAN F,Altay H,Tengiz I,Erkan A,Kılıçaslan B,OLGUN F,Durakoglugil M,Alhan A,Zoghi M Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). . 2021; 357 - 367. 10.5543/tkda.2021.63099
IEEE	Ekici B,yaman m,kucuk M,Dereli S,Yenerçağ M,Yigit Z,Baş M,KARAVELIOGLU Y,Cakmak H,KIVRAK t,ozkan h,ALTIN C,Sabanoglu C,Demirkan B,Atas A,KILICASLAN F,Altay H,Tengiz I,Erkan A,Kılıçaslan B,OLGUN F,Durakoglugil M,Alhan A,Zoghi M "Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR)." , ss.357 - 367, 2021. 10.5543/tkda.2021.63099
ISNAD	Ekici, Berkay vd. "Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR)". (2021), 357-367. https://doi.org/10.5543/tkda.2021.63099

APA	Ekici B, yaman m, kucuk M, Dereli S, Yenerçağ M, Yigit Z, Baş M, KARAVELIOGLU Y, Cakmak H, KIVRAK t, ozkan h, ALTIN C, Sabanoglu C, Demirkan B, Atas A, KILICASLAN F, Altay H, Tengiz I, Erkan A, Kılıçaslan B, OLGUN F, Durakoglugil M, Alhan A, Zoghi M (2021). Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). Türk Kardiyoloji Derneği Arşivi, 49(5), 357 - 367. 10.5543/tkda.2021.63099
Chicago	Ekici Berkay,yaman mehmet,kucuk Murathan,Dereli Seçkin,Yenerçağ Mustafa,Yigit Zerrin,Baş Mehmet Memduh,KARAVELIOGLU YUSUF,Cakmak Huseyin Altug,KIVRAK tarik,ozkan hakan,ALTIN Cihan,Sabanoglu Cengiz,Demirkan Burcu,Atas Ali Ekber,KILICASLAN FETHI,Altay Hakan,Tengiz Istemihan,Erkan Aycan Fahri,Kılıçaslan Barış,OLGUN FATIH ERKAM,Durakoglugil Murtaza Emre,Alhan Aslihan,Zoghi Mehdi Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). Türk Kardiyoloji Derneği Arşivi 49, no.5 (2021): 357 - 367. 10.5543/tkda.2021.63099
MLA	Ekici Berkay,yaman mehmet,kucuk Murathan,Dereli Seçkin,Yenerçağ Mustafa,Yigit Zerrin,Baş Mehmet Memduh,KARAVELIOGLU YUSUF,Cakmak Huseyin Altug,KIVRAK tarik,ozkan hakan,ALTIN Cihan,Sabanoglu Cengiz,Demirkan Burcu,Atas Ali Ekber,KILICASLAN FETHI,Altay Hakan,Tengiz Istemihan,Erkan Aycan Fahri,Kılıçaslan Barış,OLGUN FATIH ERKAM,Durakoglugil Murtaza Emre,Alhan Aslihan,Zoghi Mehdi Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). Türk Kardiyoloji Derneği Arşivi, vol.49, no.5, 2021, ss.357 - 367. 10.5543/tkda.2021.63099
AMA	Ekici B,yaman m,kucuk M,Dereli S,Yenerçağ M,Yigit Z,Baş M,KARAVELIOGLU Y,Cakmak H,KIVRAK t,ozkan h,ALTIN C,Sabanoglu C,Demirkan B,Atas A,KILICASLAN F,Altay H,Tengiz I,Erkan A,Kılıçaslan B,OLGUN F,Durakoglugil M,Alhan A,Zoghi M Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). Türk Kardiyoloji Derneği Arşivi. 2021; 49(5): 357 - 367. 10.5543/tkda.2021.63099
Vancouver	Ekici B,yaman m,kucuk M,Dereli S,Yenerçağ M,Yigit Z,Baş M,KARAVELIOGLU Y,Cakmak H,KIVRAK t,ozkan h,ALTIN C,Sabanoglu C,Demirkan B,Atas A,KILICASLAN F,Altay H,Tengiz I,Erkan A,Kılıçaslan B,OLGUN F,Durakoglugil M,Alhan A,Zoghi M Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR). Türk Kardiyoloji Derneği Arşivi. 2021; 49(5): 357 - 367. 10.5543/tkda.2021.63099
IEEE	Ekici B,yaman m,kucuk M,Dereli S,Yenerçağ M,Yigit Z,Baş M,KARAVELIOGLU Y,Cakmak H,KIVRAK t,ozkan h,ALTIN C,Sabanoglu C,Demirkan B,Atas A,KILICASLAN F,Altay H,Tengiz I,Erkan A,Kılıçaslan B,OLGUN F,Durakoglugil M,Alhan A,Zoghi M "Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR)." Türk Kardiyoloji Derneği Arşivi, 49, ss.357 - 367, 2021. 10.5543/tkda.2021.63099
ISNAD	Ekici, Berkay vd. "Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR)". Türk Kardiyoloji Derneği Arşivi 49/5 (2021), 357-367. https://doi.org/10.5543/tkda.2021.63099