Analysis of the Use of Sacubitril-valsartan in 252 Inpatients with Heart Failure / 中国药房

ABSTRACT

OBJECTIVE：To analyze the situation of inpatients with heart failure taking sacubitril-valsartan. METHODS ：The data of heart failture inpatients using sacubitril-valsartan in our hospital were collected during Oct. 2019 to Mar. 2020，including basic information of patients such as gender ，age，inpatient department ，length of stay ；the application of sacubitril-valsartan ， including indications ，contraindications，usage and dosage ，course of medication ；conversion with angiotensin converting enzyme inhibitor（ACEI）/angiotensin Ⅱ receptor antagonist （ARB）and adverse drug reactions ，were summarized. RESULTS ：A total of 252 cases were collected ，including 172 males（68.25％）and 80 females（31.75％）. The average age of the patients was （67.02± 14.23）years old ，and 85 cases were 75 years or older （33.73％）. Average hospitalization time was （12.03±8.19）d，the average left ventricular ejection fraction （LVEF）before medication was （38.69±10.45）％，the average blood potassium was （4.16±0.65） mmol/L，and the average estimated value of glomerular filtration （eGFR）was（69.14±32.01）mL/（min·1.73 m2）. The main distri- bution departments were cardiology department （59.14％），followed by nephrology department （8.73％），respiration department （7.14％），cardiac surgery department （5.95％），geriatrics department （5.56％），emergency medicine department （3.57％）and neurology department （3.17％）. All patients had indications ，but 25 cases（9.92％）had contraindications ，6 cases（2.38％）had blood potassium ＞5.4 mmol/L，19 cases（7.54％）had eGFR ＜15 mL/（min·1.73 m2）. The usage and dosage was 50 mg/bid （45.24％）；39 cases（15.47％）were given medicine once a day ，which was unreasonable. Average treatment course was （7.80± 5.86）d. 7 patients（2.78％）converted to ACEI ，and 3 patients（42.86％）had a conversion interval less than 36 h；20 patients （7.93％） were converted to ARB ，and there was no obvious inappropriate conversion. Hypotension occurred in 14 patients （5.56％）. Blood pressure returned to the normal range in 2 patients after drug withdrawal and 12 patients after dose reduction. No patient had adverse reactions such as involuntary muscle tremor and arrhythmia. CONCLUSIONS ： All the inpatients wit h heart failure in our hospital have indications and good safety. Only a few patients have blood pressure intolerance. However ，there were problems such as low dosage ，inappropriate frequency of administration ，drug use against contraindications，and inappropriate timing of drug conversion. Clinical pharmacists can carry out the knowledge propaganda of rational drug use ，strengthen the pharmaceutical care of patients ，timely detect the situation of irrational drug use and monitor adverse drug reactions ，and actively intervene to ensure the rationality and safety of patients ’medication.