Clinical profile, management and predictors of inhospital and short term outcomes of patients of acute heart failure

Methods: Data of 30 patients who were treated with ARNI from 2016 to 2017 were retrieved from Electronic Medical Record (CERNER) and analysed.All patients were in NYHA Class II-IV with left ventricular Ejection fraction <40%.Their clinical profiles including the hospitalisation rate,nine months prior to the commencement of ARNI were noted.They were followed for a period of twelve months for further clinical events such as rehospitalisation with heart failure, improvement in NYHA functional class, adverse effects & tolerability of medication and total mortality.Results: Total 30 patients were treated with ARNI(mean age 66.6+/13.5 years; 63.3% male, 36.7% female).Of these, 17 patients(56.7%)had Ischemic cardiomyopathy and 13(43.3%)had non-ischemic cardiomyopathy.14 patients (46.7%) had GFR <60mL/min/1.73m2.All patients were started with a dose of 50mg BID and up-titrated based on blood pressure and renal function.ARNI was discontinued in 4 patients(13.3%)bysix months,due to worsening renal function.ARNI had to be stopped in 7 patients(23.3%)by 12 months due to worsening renal function and symptomatic hypotension.Mean baseline GFR was 67.4±21mL/min/1.73m2 which deteriorated to 64.3±25mL/min/1.73m2 at 6 months and to 57.5±24mL/min/1.73m2 at 12 months (p 0.0944).Average dose of ARNI was 65mg BID at 6 months and 93.2mg BID at 12 months follow up.30% of the patients had received CRT-D.Mean LV EF was 27.8±8.2%prior to ARNI and 31.8±10.4% after 12 months(p 0.1035).Improvement in functional capacity by one class,occurred in about 50% of patients.There were a total of 39 hospitalisations with heart failure among the 30 patients up to 9 months prior to commencement of ARNI.Total number of re-hospitalisations were 17 by 6 months and 27 by 12 months after starting ARNI.Total mortality during the follow up was 10%.Conclusion: This 12 months clinical follow up study data show that ARNI is less well tolerated in our cohort population of HFrEF with high discontinuation rate and failure to up-titrate the dose.The main reasons were elderly patient population,poor renal function and multiple co-morbidities.However, we observed that there was significant improvement in functional capacity and reductions in hospitalisation rate despite majority of the patients were on small to moderate dose of ARNI.