Innovative Journal of Medical and Health Sciences

Neprilysin, a neural endopeptidase, degrades several endogenous vasoactive peptides, including natriuretic peptides, bradykinin, and adrenomedullin. Inhibition of neprilysin increases the levels of these substances, countering the neurohormonal over activation that contributes to vasoconstriction, sodium retention, and maladaptive remodeling. Sacubitril-Valsartan, a angiotensin neprilysin inhibitor when added to standard care among congestive heart failure patients, reduces the risk of cardiovascular death, heart failure hospitalizations and also it incrementally improves symptoms and physical limitations due to heart failure. There are many studies in western countries which showed neprilysin inhibition added to standard care reduces mortality and morbidity in patients with heart failure with reduced ejection fraction. But in India studies were limited, to show these facts. In this study we will compare the angiotensin receptor neprilysin inhibitor (sacubitril- valsartan) with telmisartan in patients who had heart failure with a borderline reduced ejection fraction

Methods:

Patients with heart failure those who met the inclusion criteria for the study were randomly divided into two groups namely Group one, receiving Telmisartan(40mg od) and other Group receiving sacubitril – valsartan(100mg BD) therapy in addition to standard care of heart failure. Two groups were followed up for a period of 8months and the improvement in LVEF, rehospitalisation for heart failure, reduction in NT-ProBNP levels, improvement in NYHA class, adverse events and other key parameters were observed in both the groups.

Statistical Analysis:

The data was analysed by SPSS 20.0 with unpaired t test and chi square test.

Results:

We      found  that      the       sacubitril/valsartan      group   has significant improvement in EF, reduced hospitalization for HF, improved quality of life in patients of Heart failure with EF <40%, against Telmisartan group.. Sacubitril/valsartan group has total no of hospitalisation of 5 against 16 of Telmisartan group during study period, with p value of <0.05. Sacubitril/valsartan group has an average 10% improvements in EF against 5% in Telmisartan group, which is statistically significant with p value of <0.05. The average NT-proBNP level decreased from 1259 pg/mL to 343 pg/mL in sacubitril/valsartan group with p value of <0.05.

Conclusion:

The study showed that, there is significant improvement in EF, REDUCED  hospitalization     for    HF,    improved    quality    of     life,

improvement in NYHA class and a significant reduction in NT-ProBNP    levels among      patients with HF with reduced EF<40%

initiated on sacubitril-valsartan compared to telmisartan group. Results support the use of sacubitril/valsartan in Indian patients with chronic HF with reduced ejection fraction with acceptable safety profile and treatment benefits.

The research was carried out as prospective cross-sectional and descriptive in order to evaluate the quality of life and affecting factors related to vision in individuals with vision loss in various dimensions. The population of the study consisted of all patients (308) with vision loss who were hospitalized in the eye service of a training and research hospital affiliated to the Ministry of Health of the Republic of Turkey between 03.03.2011 and 03.06.2011, and the sample consisted of 247 patients who met the sampling criteria and agreed to participate in the study. The Patient Identification Form and the National Institute of Eye Health Visual Function Questionnaire (NEI-VFQ 25) were used for data collection.In data analysis; frequency, percentile, mean, standard deviation, Kolmogorov-Smirnov distribution test, Mann Whitney U and Kruskal Wallis tests were used. As a result of the research; The Cronbach's Alpha value of the NEI-VFQ 25 was found to be reliable as 0.97. Considering that the mean scores of the patients from the subscales of the NEIVFQ 25 ranged between 38.77±15.43-76.64±30.47, the mean total score was 56.72±21.59, and the highest possible score was 100, it was determined that their visual-related quality of life was low. It has been determined that the quality of life related to vision is lower in female gender and individuals with a high degree of vision loss in the well-sighted eye.