Sacubitril/valsartan in everyday clinical practice: an observational study based on the experience of a heart failure clinic

• Type: Article in International Scientific Journal
• Date: 2021

Authors

Cabral, J (Author) Other; Vasconcelos, H (Author) Other; Maia Araujo, P (Author) Other; Moreira, E (Author) FMUP; Campelo, M (Author) FMUP; Amorim, S (Author) Other; Sousa, A (Author) FMUP; Moura, B (Author) FMUP; Pinto, R (Author) Other; Dias, C (Author) Other; Silva Cardoso, J (Author) FMUP

Journal

The Journal is awaiting validation by the Administrative Services.

Title: CARDIOVASCULAR DIAGNOSIS AND THERAPY

Vol. 11

Pages: 1217-+

ISSN: 2223-3652

Indexing

ISI Web of Knowledge - 0 Citations

Scopus - 0 Citations

Other information

Authenticus ID: P-00V-ZT9

DOI: 10.21037/cdt-21-312

Abstract (EN): Background: Heart failure (HF) is a growing public health problem. Sacubitril/valsartan is now recommended to be used in persistently symptomatic patients with left ventricular ejection fraction (LVEF) <40%, replacing angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs). In the present study, we aimed to characterise the challenges of sacubitril/valsartan use in everyday clinical practice. Methods: We assessed the medical records of patients with HF and reduced ejection fraction eligible for sacubitril/valsartan attending a HF clinic at a Portuguese University Hospital during 2018 (n=152). The number of eligible patients receiving the drug and the reasons for not prescribing sacubitril/valsartan were evaluated. Additionally, we assessed the tolerability of maximal doses of sacubitril/valsartan. New York Heart Association functional class (NYHA class) and LVEF before and after up-titration to maximal tolerated sacubitril/valsartan dose were compared. Median follow-up was 41 months. Results: Of the 152 included patients, 75 (49%) were prescribed the drug. The two main reasons for non-prescription were patient financial barriers (31%) and hypotension (27%). Only 33% of patients on sacubitril/valsartan did reach maximal dose. Hypotension was the main limiting factor for dose optimisation. Duration of sacubitril/valsartan treatment showed a positive association with LVEF improvement during follow-up (6.6% absolute LVEF increase/year). NYHA functional class improved significantly from baseline through the end of follow-up. Conclusions: In every-day clinical practice, although sacubitril/valsartan was associated with a marked improvement in NYHA class and in LVEF, important financial and clinical barriers to the implementation of this therapy were identified.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 12