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Acta Cardiol. 2019 Apr;74(2):115-122. doi: 10.1080/00015385.2018.1473825. Epub 2018 Jun 17.

Impact of sacubitril/valsartan on heart failure admissions: insights from real-world patient prescriptions.

Author information

1
a Department of Cardiology , Ziekenhuis Oost-Limburg , Genk , Belgium.
2
b Doctoral School for Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.
3
c Biomedical Research Institute, Faculty of Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.

Erratum in

Abstract

BACKGROUND:

Sacubitril/valsartan reduced heart failure (HF)-admissions and cardiovascular mortality in the PARADIGM-HF-trial. However, real-world patients are often frailer and less able to tolerate high doses of sacubitril/valsartan.

METHODS:

We performed a retrospective analysis of consecutive patients prescribed sacubitril/valsartan in a single tertiary HF-clinic between December 2016 and January 2018. HF-admissions were assessed in a paired fashion, comparing the amount of antecedent HF-episodes with incident HF-episodes after the initiation. Baseline risk for adverse events was assessed by the EMPHASIS-HF-risk-score.

RESULTS:

A total of 201-HF-patients were retrospectively identified (age = 68 ± 11 years, ejection fraction = 29 ± 8%). Real world patients were older, had higher serum creatinine and a higher New-York Heart-Association (NYHA)-class (p < .05 for all) than in the PARADIGM-HF trial. Over a mean duration of 221 ± 114 days after initiation of sacubitril/valsartan a total of 23-individual patients experienced at least one HF-episodes. Over the same time period preceding initiation of sacubitril/valsartan, 51 individual patients experienced a HF-episodes (p < .001). Sacubitril/valsartan significantly reduced the rate of incident vs. antecedent HF-admissions, in patients with low or high baseline NYHA-class (II vs. III and IV; p value = 0.019 respectively p = .004) or patients with an EMPHASIS-HF risk score below or above the mean (p = .002 respectively p = .016). Patients older than 75-years exhibited a trend towards HF-reduction. Higher doses of sacubitril/valsartan were associated with more reduction in incident versus antecedent HF-episodes.

CONCLUSION:

Despite being frailer and older, real-world patients exhibit a significant and early reduction in incident HF-hospitalisations following initiation of sacubitril/valsartan. Higher doses might be associated with more reduction in HF-admissions, underscoring the importance of dose uptitration.

KEYWORDS:

Sacubitril/valsartan; heart failure; hospitalizations; pharmacology

PMID:
29909743
DOI:
10.1080/00015385.2018.1473825
[Indexed for MEDLINE]

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