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

Abstract

Background:
Heart failure is known as defect in blood ejection from heart attained from structural or
functional cardiac disorders which lead in impairment in the ability of the ventricle to fill
with or eject blood, ended with complex clinical syndrome with significant symptoms and
clinical signs1,2. HF influences 23-26 million patients globally.4,5 Ischemic heart disease,
myocardial infarction, hypertension, and valvular heart disease considered as the major
reasons of heart failure .The combination of an angiotensin II receptor antagonist and a
neprilysin inhibitor is a novel choice in heart failure management.17
Patients and Methods:
This is an interventional study which has been performed in the Teaching Cardiac Center
in Thi-Qar 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 socio-demographic 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%) from
them had initial increment in ejection fraction by about (4 -8%). Good prognosis regarding
vital 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 changed safely to sacubitril/valsartan (ARNI), to obtain additional
decreases in 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.