Impact of sacubitril/valsartan on heart failure admissions: insights from real-world patient prescriptions
- 17 June 2018
- journal article
- research article
- Published by Informa UK Limited in Acta Cardiologica
- Vol. 74 (2), 115-122
- https://doi.org/10.1080/00015385.2018.1473825
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
Funding Information
- FWO (1127917N)
This publication has 12 references indexed in Scilit:
- Insights into implementation of sacubitril/valsartan into clinical practiceESC Heart Failure, 2018
- Effects of intravenous home dobutamine in palliative end‐stage heart failure on quality of life, heart failure hospitalization, and cost expenditureESC Heart Failure, 2018
- Sacubitril–Valsartan in Heart Failure: Why Are More Physicians Not Prescribing It?Annals of Internal Medicine, 2016
- Efficacy of sacubitril/valsartan vs. enalapril at lower than target doses in heart failure with reduced ejection fraction: the PARADIGM‐HF trialEuropean Journal of Heart Failure, 2016
- Factors Associated With Noncompletion During the Run-In Period Before Randomization and Influence on the Estimated Benefit of LCZ696 in the PARADIGM-HF TrialCirculation: Heart Failure, 2016
- Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HFEuropean Heart Journal, 2015
- Angiotensin–Neprilysin Inhibition versus Enalapril in Heart FailureNew England Journal of Medicine, 2014
- Baseline characteristics and treatment of patients in Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM‐HF)European Journal of Heart Failure, 2014
- The impact of eplerenone at different levels of risk in patients with systolic heart failure and mild symptoms: insight from a novel risk score for prognosis derived from the EMPHASIS-HF trialEuropean Heart Journal, 2013
- Effect of Enalapril on Survival in Patients with Reduced Left Ventricular Ejection Fractions and Congestive Heart FailureNew England Journal of Medicine, 1991