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. 2023 Nov 10;120(8):e20220611.
doi: 10.36660/abc.20220611. eCollection 2023.

Effect on the Quality of Life of Patients with Heart Failure and Reduced/Preserved Ejection Fraction Using Sacubitril/Valsartan

[Article in English, Portuguese]
Yuanrui Huang  1 , Xu Wu  2 , Xingyu Li  3 , Zhengzhong Liu  4 , Yunyi Li  5
Affiliations

Effect on the Quality of Life of Patients with Heart Failure and Reduced/Preserved Ejection Fraction Using Sacubitril/Valsartan

[Article in English, Portuguese]
Yuanrui Huang et al. Arq Bras Cardiol. .

Abstract
in English, Portuguese

Background: Heart failure (HF) management has markedly improved, but a clinically meaningful improvement in functional capacity and quality of life is perhaps more important for patients than living longer.

Objective: This study aimed to review the improvement in quality of life with sacubitril/valsartan in patients with HF and reduced/preserved ejection fraction (EF) from prospective clinical trials.

Methods: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) and prospective cohort studies published from inception to July 2021. A total of 6 clinical trials and 16854 patients with HF were included. The primary outcome was the change from baseline in KCCQ clinical summary score. The secondary outcomes were scores in other domains of KCCQ, the occurrence of serious adverse events (AEs), and overall mortality. P-values <0.05 were considered statistically significant.

Results: Treatment of sacubitril/valsartan showed significantly higher KCCQ-CSS compared to the control (WMD=0.975, 95% CI: 0.885, 1.064, p<0.001; I2=94.8%, pheterogeneity<0.001). A significant decrease in the mortality rate was observed in the sacubitril/valsartan group compared to the control group (RR=0.895, 95%CI:0.831, 0.965, p=0.004; I2=43.6%, pheterogeneity=0.150). Nevertheless, no significant reduction in the occurrence of serious AEs was found among HF patients treated with sacubitril/valsartan compared to the control group (RR=0.950, 95%CI: 0.879, 1.027, p<0.001; I2=68.1%, pheterogeneity=0.024).

Conclusions: Our study demonstrated that sacubitril/valsartan might significantly improve the HRQL compared to other treatments according to the results in KCCQ-CSS and some subdomains in the KCCQ index during the follow-up in patients with HF.

Fundamento: O manejo da insuficiência cardíaca (IC) tem melhorado acentuadamente, mas uma melhora clinicamente significativa na capacidade funcional e na qualidade de vida talvez seja mais importante para os pacientes do que viver mais.

Objetivo: Este estudo teve como objetivo revisar a melhora na qualidade de vida com sacubitril/valsartan em pacientes com IC e fração de ejeção (FE) reduzida/preservada a partir de ensaios clínicos prospectivos.

Métodos: PubMed, Embase e Cochrane Library foram pesquisados em busca de ensaios clínicos randomizados (ECRs) e estudos de coorte prospectivos publicados desde o início até julho de 2021. Um total de 6 ensaios clínicos e 16.854 pacientes com IC foram incluídos. O desfecho primário foi a alteração da linha de base na pontuação do resumo clínico do KCCQ. Os desfechos secundários foram pontuações em outros domínios do KCCQ, ocorrência de eventos adversos graves (EAs) e mortalidade geral. Valores de p < 0,05 foram considerados estatisticamente significativos.

Resultados: O tratamento de sacubitril/valsartan mostrou KCCQ-CSS significativamente maior em comparação com o controle (DMP=0,975, IC 95%:0,885, 1,064, p<0,001; I2=94,8%, pheterogeneidade<0,001). Uma diminuição significativa na taxa de mortalidade foi observada no grupo sacubitril/valsartan em comparação com o grupo controle (RR=0,895, IC 95%: 0,831, 0,965, p=0,004; I2=43,6%, pheterogeneidade=0,150). No entanto, nenhuma redução significativa na ocorrência de EAs graves foi encontrada entre pacientes com IC tratados com sacubitril/valsartan em comparação com o grupo controle (RR=0,950, IC 95%: 0,879, 1,027, p<0,001; I2=68,1%, pheterogeneidade= 0,024).

Conclusões: Nosso estudo demonstrou que o sacubitril/valsartan pode melhorar significativamente a QVRS em comparação com outros tratamentos de acordo com os resultados do KCCQ-CSS e alguns subdomínios do índice KCCQ durante o acompanhamento em pacientes com IC.

PubMed Disclaimer

Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

None
Diagrama de Fluxo do PRISMA 2009.
Figura 1
Figura 1. Comparação dos grupos sacubitril/valsartana e controle no KCCQ-Clinical Summary Score. DMP: diferenças médias ponderadas.
Figura 2
Figura 2. Comparação dos grupos sacubitril/valsartana e controle quanto à ocorrência de eventos adversos graves. RR: risco relativo.
Figura 3
Figura 3. Comparação dos grupos sacubitril/valsartan e controle na mortalidade geral. RR: risco relativo.
Figura 4
Figura 4. Forest plot para KCCQ-Clinical Summary Score comparando o grupo sacubitril/valsartan com o grupo controle pelo nível da fração de ejeção do ventrículo esquerdo na inclusão. DMP: diferenças médias ponderadas; FEVE: fração de ejeção do ventrículo esquerdo.
None
PRISMA 2009 Flow Diagram.
Figure 1
Figure 1. Comparing the sacubitril/valsartan and the control groups on KCCQ-Clinical Summary Score. WMD: weighted mean differences.
Figure 2
Figure 2. Comparing the sacubitril/valsartan and the control groups on the occurrence of serious adverse events. RR: relative risk.
Figure 3
Figure 3. Comparing the sacubitril/valsartan and control groups on the overall mortality. RR: relative risk.
Figure 4
Figure 4. Forest plot for KCCQ-Clinical Summary Score comparing the sacubitril/valsartan group with the control group by the left ventricular ejection fraction level at inclusion. WMD: weighted mean differences; LVEF: left ventricular ejection fraction.
See this image and copyright information in PMC

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