Cognitive performance of patients with chronic heart failure on sacubitril/valsartan A retrospective cohort study

• Published in: Herz Vol. 44; no. 6; pp. 534 - 540
• Main Authors: De Vecchis, R., Ariano, C., Di Biase, G., Noutsias, M.
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer Medizin 01.09.2019
• Subjects: Aminobutyrates - adverse effects; Aminobutyrates - therapeutic use; Angiotensin II Type 1 Receptor Blockers - adverse effects; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin Receptor Antagonists - adverse effects; Angiotensin Receptor Antagonists - therapeutic use; Cardiology; Cognition - drug effects; Drug Combinations; Heart Failure - drug therapy; Heart Failure - psychology; Humans; Internal Medicine; Medicine; Medicine & Public Health; Original Articles; Retrospective Studies; Stroke Volume; Tetrazoles - adverse effects; Tetrazoles - therapeutic use; Valsartan - therapeutic use; Neurologic manifestations; Neurologische Manifestationen; Unerwünschte Arzneimittelnebenwirkungen; Adverse drug events; Neprilysin inhibitor; Neprilysin-Inhibitor; Mini-Mental-Status-Test; Cardiac insufficiency; Mini-Mental State Examination; Herzinsuffizienz
• ISSN: 0340-9937; 1615-6692; 1615-6692
• DOI: 10.1007/s00059-018-4683-5

Background Sacubitril, a neprilysin inhibitor in the combination molecule sacubitril/valsartan, slows down degradation of endogenous natriuretic peptides, thereby enhancing their beneficial cardiovascular effects. However, sacubitril might also promote neuronal dysfunction and cognitive impairment in patients with chronic heart failure (CHF) treated with sacubitril/valsartan, due to possible neprilysin inhibition at the level of Central Nervous System. Methods A retrospective cohort study was undertaken to detect the effects exerted by sacubitril/valsartan on cognitive function in CHF patients. The patients’ clinical data were examined for information provided in the Mini-Mental State Examination (MMSE), which was routinely administered during clinical visits at two centers from 15 March to 31 October 2017. Patients in the sacubitril/valsartan group had a clinical history of at least 3 months of continuous sacubitril/valsartan administration. The control group comprised CHF patients on conventional therapy not taking sacubitril/valsartan. In the between-group comparison, patients were matched for mean age, educational level, sex, NYHA class, and comorbidities. In the present retrospective study only patients in NYHA class II-III were enrolled. Results The mean MMSE score was 22.72 ± 2.68 (mean ± standard deviation [SD]) in the sacubitril/valsartan group ( n  = 51 patients) vs. 21.96 ± 2.73 (mean ± SD) in the control group ( n  = 51; p  = 0.1572, independent samples t -test). Thus, a similar mild-to-moderate impairment in cognitive performance was found in the comparison between the two groups. Conclusion In our study, we did not find any evidence of the alleged harmful influence of sacubitril/valsartan on cognitive function. Patients taking sacubitril/valsartan for at least 3 months had similar mean MMSE scores to control subjects.