Evaluation of Valsartan-Sacubitril for Heart Failure in Thi Qar Patients / Iraq

Abstract

Background:
Heart failure (HF) is defined as any structural and/or functional impairment of cardiac blood ejection raised from a
structural or functional cardiac disorders that impair the ability of the ventricle to fill with or eject blood, leads to a
complex clinical syndrome with typical symptoms and clinical signs1,2. HF influences 23-26 million patients
globally.4,5 The major causes of HF include ischemic heart disease (IHD) ,myocardial infarction (MI), hypertension,
and valvular heart disease (VHD). The association of an angiotensin II receptor antagonist and a neprilysin inhibitor
is a new actor in HF management.18
Patients and Methods:
This is an observational analytical Cohort study which has been performed in the Teaching Cardiac Center in ThiQar Governorate in Nasiriyah city in Iraq. All participants are patients who either recently diagnosed as heart failure
(6 months to 1 year) or diagnosed since (1 to 3 years). Key criteria for the study has been involved sociodemographic characteristics as age (years) (40-60 or more than 60), Body Mass Index(BMI), educational level of
patients, occupation, history of tobacco smoking or alcohol intake, the history of co-morbidities as Atrial
fibrillation (AF), Diabetes Mellitus (DM) (types I and II), Dyslipidemia, Chronic kidney disease(CKD) and Chronic
obstructive pulmonary disease(COPD).
Results:
The number of both genders is equal in my study. After 6 weeks follow up period from starting to take ARNI,
(27.02%) of them improved regarding EF. About (72.98%) of them had initial increament in ejection fraction by
about (4 -8%). Good prognosis regarding signs and symptoms of heart failure were remarkable.
Conclusion:
- Chronic symptomatic patients with HFrEF ( NYHA class II or III ) who tolerate an ACEI or ARB can be
switched safely to sacubitril/valsartan (ARNI), to further reduce morbidity and mortality.
- The main barrier that prevents cardiologists in Thi Qar to prescribe ARNI is the cost of the drug because
most of the Iraqi patients are unable to buy this expensive medication.
Recommendations:
1-All patients with HFrEF (NYHA class II - III) should receive ARNI.
2-This medication should be provided in all Iraqi hospitals and Cardiac centers because this drug is very expensive
and patients may not be able to buy it.
3-Explaining the concept of the medication related burden and further studies are recommended to include
adherence assessment of patients toward treatment.