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1 Sacubitril/valsartan in chronic symptomatic heart failure with reduced ejection fraction: first clinical experience from a large uk tertiary centre
  1. Danish Ali,
  2. Fiona Riley,
  3. Stephanie Kirkland,
  4. Jacqui Hyland,
  5. Prithwish Banerjee
  1. Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust

Abstract

Introduction Sacubitril/valsartan (SV) is a new drug that has recently been approved by the National Institute for Health and Care Excellence (NICE) to be used as an alternative to ACE-inhibitors/Angiotensin Receptor Blockers in patients with symptomatic chronic heart failure with reduced ejection fraction (HFrEF). We report an early clinical experience of SV use in HF patients at a large tertiary cardiac centre in the UK.

Methods Patients with HFrEF (NYHA class II-IV and Left Ventricular Ejection Fraction <35%) seen in the heart failure clinic and started on Sacubtril/valsartan (one tablet 49/51 mg twice daily) from April till October 2016, were retrospectively evaluated. Change in NHYA class, eGFR, up-titration to target dose (one tablet 97/103 mg twice daily), deaths, hospitalizations and patients tolerability to SV were assessed. All patients had either their ACE-inhibitor or angiotensin receptor antagonist stopped at least 48 hours prior to starting sacubtril/valsartan and re-attended the HF clinic at 4 weekly intervals until up-titration was completed.

Results A total of 44 patients were commenced on SV and in 25 patients (57%) up-titration to the target dose was achieved. In 12 patients (27%) an improvement of NYHA class was seen. Nine patients (20%) had symptomatic systolic blood pressure drop of >10 mmHg at follow-up with 3 patients having hyperkalaemia (7%), preventing target dose up-titration. A total of 4 hospital admissions occurred: 2 due to decompensated heart failure (5%), 1 for hyperkalaemia and 1 non-cardiovascular (CV) related. Out of those hospital admissions, 2 patients died (see table). Four patients (9%) had a worsening of the eGFR>10 (without progressive renal failure preventing up-titration) and in 2 patients (5%) the drug was stopped to due intolerability (reported postural dizziness and abdominal pain).

Conclusion The clinical use of SV in our centre has a high rate of tolerability with significant improvement in NYHA class (27%). However, in a large proportion of patients the target dose was not achieved (43%), mainly due to symptomatic hypotension and secondly due to hyperkalaemia (7%). A significant number of patients had a drop in eGFR, but this did not prevent up-titration. Our results confirm that HFrEF patients commencing sacubitril/valsartan require close monitoring of symptoms, renal function and dose titration by a ?specialist heart failure team.

Abstract 1 Table 1

  • sacubitril/valsartan
  • heart failure with reduced ejection fraction
  • target dose

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