Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado

Author
Rossel, Víctor; Hospital del Salvador. Universidad de Chile

Duarte, Manuel; Universidad de Chile

Muñoz, Pilar; Universidad de Chile Hospital del Salvador

Bravo, Catherine; Hospital del Salvador

Bobadilla, Gustavo; Universidad de Los Andes

Verdugo, Fernando; Universidad de Chile

Guardamagna, Carmen; Hospital del Salvador

Full text
http://www.revistamedicadechile.cl/ojs/index.php/rmedica/article/view/6832
Abstract
Background: Pharmacological treatment improves survival in patients with heart failure with reduced ejection fraction. The use of sacubutril / valsartan and ivabradine has been recently approved and incorporated in the latest guidelines. Aim: To identify candidates eligible for these therapies among patients treated in a heart failure clinic, considering the inclusion criteria for the PARADIGM-HF and SHIFT trials. Material and methods: Cross-sectional study in 158 patients aged 62 ± 11 years (67% male) with heart failure and reduced ejection fraction, with at least three months of follow-up and without decompensation. The percentage of patients complying for the inclusion criteria for the PARADIGM-HF y SHIFT trials was determined. Results: In 37%, the etiology of heart failure was ischemic, 49% were in functional class I, their ejection fraction was 33 ± 11% and their median Pro-brain natriuretic peptide was 800 pg/mL. Ninety five percent were treated with vasodilators, 97% with beta-blockers and 82% with aldosterone antagonists. Using PARADIGM-HF and SHIFT criteria, 11 patients (7%) were eligible for sacubitril / valsartan and 21 patients (13.3%) for ivabradine. Among the main causes of non-eligibility for sacubitril / valsartan were being functional class I (48.7%) and not achieving a stable dose of enalapril ? 20 mg / day or losartan ? 100 mg / day (24.7%). In the case of ivabradine, apart from those in functional class I, the absence of sinus rhythm and a heart rate
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