Jahanzeb Malik1, Nismat Javed2,

1Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan, 2Shifa College of Medicine, Islamabad, Pakistan

Background:
In patients with heart failure with reduced ejection fraction (HFrEF), there is an increased propensity for anxiety and depression disorders and there is an association of adverse cardiovascular events. Sacubitril/Valsartan is an angiotensin receptor neprilysin inhibitor (ARNI), which has shown to reduce cardiovascular morbidity and mortality in patients with HFrEF. However, its effects on anxiety and depression is still not clear.

Method(s):
Sacubitril/Valsartan was started in 216 patients with New York Heart Association (NYHA) III/IV symptoms of heart failure despite guideline-directed medical therapy (GDMT). For functional status, the NYHA class and a 6-minute walk test (6-MWT) were administered. The Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were used for anxiety and depression at the time of the switch to ARNI and at the sixth-moth follow-up.

Result(s):
There was a significant improvement in BAI and BDI scores when compared before and after the sacubitril/valsartan treatment (14.2±7.3 to 7.4±3.6, p<0.001, and 13.8±9.2 to 9.5±4.6, p<0.03). The 6-MWT distance increased significantly from 189±67 to 310±98 meters (p<0.001). Forty-one percent of the patients improved by one NYHA class, 48% by one NYHA class, and remained stable.

Conclusion(s):
In patients with HFrEF, a switch to ARNI resulted in a significant improvement in functional status, depression, and anxiety states.