The Effectiveness and Tolerability of Switching Patients from Sacubitril/Valsartan, ARNI to Perindopril in Heart Failure with Reduced Ejection Fraction: EFFICIENT Trial

Abstract

Objectives Heart failure with reduced ejection fraction (HFrEF) is an advancing illness that can be managed with various drugs. In this study, we present data on the tolerance of perindopril in patients with HFrEF who were switched from angiotensin receptor neprilysin inhibitor (ARNI) to perindopril because of issues with the former’s tolerability or increased medication costs. Methods A total of 125 patients with HFrEF were switched to perindopril in this retrospective study carried out at the heart failure clinic. Of those, 109 patients had data accessible for a 6-month follow-up. The data of the patients who switched from ARNI to perindopril between June and December 2023 were collected. Data such as the New York Heart Association (NYHA) class, N-terminal pro hormone brain natriuretic peptide (NT-proBNP), and left ventricular ejection fraction (LVEF) were compared at baseline and 6-month follow- up with those collected after the switchover. Results During the transition, the average age was 58 ± 13 years (mean ± standard deviation), the disease duration was 2.6 ± 1.4 years, and 29.6% of the patients were female. The average period of follow-up following the transition was 5.7 ± 1.5 months. The 6-minute walk distance (6MWD) reduced from 344 ± 106 to 319 ± 85 m ( P = .056), but the NT-pro BNP levels increased from 478 ± 170 to 490 ± 137 pg/mL ( P = .56) after the transfer. All patients continued to maintain their NYHA functional class after the transition, with no significant difference seen ( P = .37). There was a little improvement in LVEF from 40% ± 4% to 41.5% ± 5% ( P < .001) during the follow-up after the switchover. Following the transition, no changes were observed in vital indicators, serum electrolytes, and creatinine levels. All patients successfully tolerated the transition to perindopril. Conclusions The transfer from ARNI to perindopril was both well tolerated and safe. The patients’ functional condition remained unchanged, as did their NT-pro BNP levels. A modest improvement in LVEF was noted. In India, switching from ARNI to perindopril is less expensive.