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Tolerability and efficacy of sacubitril/valsartan in clinical practice
Author(s) -
Nandal Savvy,
Chow Chee Loong,
Hannah Vikki,
Vaddadi Gautam,
Van Gaal William
Publication year - 2021
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14749
Subject(s) - sacubitril , medicine , sacubitril, valsartan , valsartan , tolerability , ejection fraction , blood pressure , heart failure , cardiology , enalapril , adverse effect , angiotensin converting enzyme
Background Heart failure (HF) is a major cause of morbidity and mortality. Sacubitril/valsartan has demonstrated reductions in HF hospitalisation, and all‐cause mortality in patients with heart failure with reduced ejection fraction. Aims To assess the tolerability and efficacy of sacubitril/valsartan in an intention to treat patient cohort. Methods Sixty‐five patients who were commenced on sacubitril/valsartan in 2017 at a major metropolitan centre in Victoria were retrospectively audited. Clinical outcomes and quality of life scores were obtained pre and post sacubitril/valsartan commencement through phone and regular clinic follow up, 6–12 months after commencement of sacubitril/valsartan. Results Fourteen percent of patients were able to achieve maximal dose (97/103 mg twice daily) whilst 37% remained on 49/51 mg and 23% on 24/26 mg. The mean systolic blood pressure reduced from 118 ± 18 mmHg to 109 ± 15 mmHg with symptomatic hypotension (30%) being the most common side‐effect leading to dose reduction or drug cessation. Left ventricular ejection fraction improved from 29.1 ± 9.7% to 33.8 ± 9.9% ( P < 0.05) on drug. There was also a significant improvement in quality of life scores; EQ5D‐VAS 40 pre versus 67 post sacubitril/valsartan ( P < 0.05), and New York Heart Association class ( P < 0.05). Importantly, 10 patients lost an existing indication for device based therapy after treatment with sacubitril/valsartan. Conclusions Sacubitril/valsartan is a much needed therapeutic advancement in the treatment of HF. Our study indicates it is well tolerated with improvements in cardiac function and symptoms. Sacubitril/valsartan could redefine the definition of ‘optimal medical therapy’ when assessing patients for device based therapies.