A study by the Faculty of Medicine of the University of Porto (FMUP) concluded that starting two treatments simultaneously in patients with heart failure is feasible and safe and can allow patients to receive treatment recommended by international guidelines.
“This finding is relevant because many doctors hesitate to start several medications at the same time for fear of adverse effects. This study suggests that, with adequate monitoring, a faster approach is viable and safe”, says professor and researcher at FMUP João Pedro Ferreira, cited in a statement.
Published no in January, this study evaluated patients with heart failure with reduced ejection fraction, a type of heart failure in which the heart has difficulty pumping blood effectively.
The patients were being monitored in several centers in the North of the country, namely in the São João and Santo António Local Health Units, in Porto, Gaia/Espinho and Matosinhos.
According to the study’s lead author, “international guidelines recommend that drugs be started as early as possible and doses adjusted.
“Before this trial, it was not known whether it was safe and effective to start them simultaneously or whether it would be better to start one and then the other, one to three months later”, explained the researcher who is also part of the RISE-Health research unit.
Thus, this research demonstrated that “the strategy is safe, which means that it does not increase adverse effects when compared to the strategy of starting treatment with just one medication and adding the other after a few weeks or months”, he added. To reach this conclusion, the authors analyzed the patients over about six months.
According to the summary sent to Lusa, the focus was on the occurrence of relevant clinical events and common adverse effects, such as, for example, too low blood pressure, dangerous changes in potassium and kidney function, emergency room visits and hospitalizations for heart failure and mortality due to cardiovascular causes.
This investigation tested the simultaneous or sequential initiation of “pillar” therapies in the treatment of this pathology (sacubitril/valsartan) and SGLT2 inhibitors, which in addition to heart failure are also indicated in patients with diabetes and/or chronic kidney disease.
In total, 62 participants were included – 29 in the simultaneous group and 33 in the sequential group – with an average age of 68 years and the majority were male, according to the epidemiology of the disease.
“There was no increase in serious complications in the group that started both medications simultaneously”, guarantees João Pedro Ferreira, highlighting that “after 12 weeks, all patients who continued in the study were already taking both medications and the majority managed to reach target doses by 24 weeks”.
“There were no signs of worse renal tolerance, severe low blood pressure or serious changes in potassium in the simultaneous group”, concluded João Pedro Ferreira, who, at FMUP, has been following a line of research that aims to improve the treatment of cardiovascular, renal and metabolic diseases.
Heart failure is a serious chronic disease that causes symptoms such as shortness of breath and fluid retention and is one of the main causes of mortality over 65 years of age.
