Pacientes en tratamiento con sacubitrilo-valsartán que presentan una descompensación en forma de insuficiencia cardiaca aguda: análisis de la actitud en urgencias y durante la hospitalización

espanolObjetivo. Identificar el patron de practica clinica habitual respecto al tratamiento cronico con sacubitrilo-valsartan (SV) durante los episodios de insuficiencia cardiaca aguda (ICA), sus determinantes y su efecto sobre la evolucion. Metodo. Estudio exploratorio de pacientes con ICA incluidos en el Registro EAHFE-6 en tratamiento cronico con SV. Se recogieron caracteristicas basales, del episodio y del tratamiento con SV, y se identificaron factores relacionados con la interrupcion de SV y su asociacion con eventos adversos 180 dias postevento indice (mortalidad por cualquier causa) y postalta (reconsulta a urgencias u hospitalizacion por ICA, muerte o evento combinado). Resultados. Se incluyeron 50 pacientes (mediana desde inicio de SV: 81 dias; RIC: 43-284) y SV se interrumpio en 19 casos (38%; 5 en urgencias, 14 en hospitalizacion). Se identifico un motivo de retirada en 16 casos (4 por insuficiencia renal; y 3 por hipotension arterial, hiperpotasemia, debilidad/mareo y empeoramiento de ICA, respectivamente). La retirada de SV se asocio con edad avanzada, no estar en tratamiento con betabloqueantes e hiperpotasemia. No hubo diferencias significativas entre grupos en eventos adversos a los 180 dias postevento indice o postalta. Conclusion. En los pacientes en tratamiento cronico con SV que presentan ICA, este es suspendido en mas de un tercio de casos, si bien ello no se asocia con cambios evolutivos. EnglishObjectives. To describe the pattern of care usually given to patients with acute heart failure (AHF) who are taking sacubitril/valsartan (SV) and to explore the effects of care characteristics on clinical outcomes. Methods. Exploratory study of AHF cases in patients taking SV who were included in the register for the Epidemiology of Acute Heart Failure in Emergency Departments during the sixth period of data collection (EAHFE-6). We extracted baseline and episode variables and information related to SV treatment. We also analyzed associations between the discontinuation of SV therapy and adverse events within 180 days (all-cause mortality) and after discharge (emergency revisits, admission for AHF, death from any cause, or a composite event). Results. Fifty patients on SV were included. The median time on SV therapy was 81 days (interquartile range, 43–284 days). SV was discontinued in 19 cases (38%; 5 in the emergency department and 14 on the ward). Sixteen records specified the reason for discontinuing SV: renal insufficiency, 4 cases; arterial hypotension, 3; weakness/dizziness, 3; and exacerbated AHF, 3. SV discontinuation was associated with older age, absence of treatment with a betablocker, and hyperkalemia. The EAHFE-6 cases did not reveal significant differences related to SV discontinuation with respect to the rates of adverse events within 180 days or on discharge after the index event. Conclusions. Long-term SV therapy is discontinued in over a third of patients who present with exacerbated AHF even though no association with clinical outcomes could be identified.