Open AccessImplementation of sacubitril/valsartan in Sweden: clinical characteristics, titration patterns, and determinants
Author(s) -
Fu Michael,
Vedin Ola,
Svennblad Bodil,
Lampa Erik,
Johansson Daniel,
Dahlström Ulf,
Lindmark Krister,
Vasko Peter,
Lundberg Anna,
CostaScharplatz Madlaina,
Lund Lars H.
Publication year - 2020
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.12883
Subject(s) - medicine , hazard ratio , ejection fraction , discontinuation , sacubitril, valsartan , heart failure , cohort , valsartan , confidence interval , medical prescription , sacubitril , cohort study , cardiology , surgery , blood pressure , pharmacology
Aims The aim of this study is to study the introduction of sacubitril/valsartan (sac/val) in Sweden with regards to regional differences, clinical characteristics, titration patterns, and determinants of use and discontinuation. Methods and results A national cohort of heart failure was defined from the Swedish Prescribed Drug Register and National Patient Register. A subcohort with additional data from the Swedish Heart Failure Registry (SwedeHF) was also studied. Cohorts were subdivided as per sac/val prescription and registration in SwedeHF. Median sac/val prescription rate was 20 per 100 000 inhabitants. Between April 2016 and December 2017, we identified 2037 patients with ≥1 sac/val prescription, of which 1144 (56%) were registered in SwedeHF. Overall, patients prescribed with sac/val were younger, more frequently male, and had less prior cardiovascular disease than non‐sac/val patients. In SwedeHF subcohort, patients prescribed with sac/val had lower ejection fraction. Overall, younger age [hazard ratio 2.81 (95% confidence interval 2.45–3.22)], registration in SwedeHF [1.97 (1.83–2.12)], male gender [1.50 (1.37–1.64)], ischaemic heart disease [1.50 (1.39–1.62)], lower left ventricular ejection fraction [3.06 (2.18–4.31)], and New York Heart Association IV [1.50 (1.22–1.84)] were predictors for sac/val use. As initiation dose in the sac/val cohort, 38% received 24/26 mg, 54% 49/51 mg, and 9% 97/103 mg. Up‐titration to the target dose was achieved in 57% of the overall cohort over a median follow‐up of 6 months. The estimated treatment persistence for any dose at 360 days was 82%. Conclusions Implementation of sac/val in Sweden was slow and varied five‐fold across different regions; younger age, male, SwedeHF registration, and ischaemic heart disease were among the independent predictors of receiving sac/val. Overall, treatment persistence and tolerability was high.