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ANGIOTENSIN RECEPTOR–NEPRILYSIN INHIBITORS (ARNI) AND TOLERABILITY IN HEART FAILURE PATIENTS – A RETROSPECTIVE OBSERVATIONAL STUDY FROM PRINCE SULTAN CARDIAC CENTRE

FADWA ALKHURAISI 1, FAISAL ALQARNI 2, OTHMAN DAGHRIRI 1, TURKI ALGARNI 1, ALI ALQAHTANI 2, WAJID SYED 3*, MAHMOOD BASIL A. AL-RAWI 4

1Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
2 Department of Pharmacy, Security Forces Hospital, Riyadh, Saudi Arabia
3 Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
4 Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia

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Angiotensin receptor neprilysin inhibitor (ARNI) is a new class of drugs for heart failure with reduced ejection fraction (HFrEF). According to the guidelines' recommendations, replacing angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) with an ARNI is recommended to further reduce morbidity and mortality. This study aimed to assess the extent of the clinician's adherence to the equivalent doses of ARNI and the patient tolerability to ARNI doses. This is a retrospective observational study that took place at Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia, conducted on heart failure patients who were shifted from ACE inhibitors or ARBs to ARNI from January 2017 to November 2019. A descriptive analysis was conducted to assess the prevalence and sociodemographic factors of the study population. Of 450 patients, 304 (67.5%) started on the equivalent dose of ARNI, the dose intolerance occurred in 21 patients (30%) who received a dose higher than the equivalent dose, as compared with 13 (5.4%) patients who received an equivalent dose (odds ratio, 7.52; 95% confidence interval [CI], 3.52 - 16.03; p < 0.001). Among patients whose treatments were changed from ACE inhibitors or ARBs to ARNI, only 65.5% of them were switched to the equivalent doses of ARNI. Moreover, our study found that switching to a higher dose might increase the incidence of dose intolerance by 7.52 times more than that of switching to an equivalent dose. A generation of standardized protocols and electronic decision support would help to facilitate the switching to a proper dose and ensure better dose tolerability.