Sacubitril/valsartan in chronic heart failure – early clinical experience from a tertiary centre

Danish Ali; Jacqui Hyland; Fiona Riley; Stephanie Kirkland; Sarah Al Bared; Parekh Rajen; Lisa Hinitt; Catherine Watson; Hayley Nicholson; Umar Fraz; Prithwish Banerjee

doi:10.7861/clinmedicine.19-2-s21

Aims

We report our clinical experience of sacubitril/valsartan (SV) use in heart failure (HF) patients at a large UK cardiac centre.

Methods

Heart failure with reduced ejection fraction (HFrEF) patients seen in the HF clinic and started on SV from April 2016 to July 2017 were retrospectively evaluated. Change in New York Heart Association (NYHA) class, estimated glomerular filtration rate (eGFR), up-titration to target dose and tolerability to SV were assessed. Six-month and 1-year outcomes of mortality and HF hospitalisations were evaluated. Patients were seen in the nurse-led, cardiologist-supervised, HF clinic at 4-weekly intervals until up-titration to maximum tolerated dose.

Results

A total of 140 patients were included (Table 1) and in 77 patients (55%) up-titration to the target dose was achieved (Table 2). An improvement of NYHA class was seen in 43 (31%) patients and left ventricular ejection fraction (LVEF) improved in 23 (66%) patients. 44 (31%) patients had symptomatic systolic blood pressure drop of >10 mmHg at follow up preventing target dose up-titration. Eight (6%) HF admissions and five (4%) in-hospital deaths occurred in 6 months. Of the total cohort of 140, 1-year outcome was observed in 68 patients with a mortality of 7% (n=5) and HF admission of 6% (n=4). Fifteen (10%) patients had a worsening of the eGFR >10 and in 11 (8%) patients SV was stopped to due intolerability.

Conclusion

The clinical use of SV in our centre has a high rate of tolerability with significant improvement in NYHA class (31%) and excellent 6-month and 1-year outcomes. However, in a large proportion of patients, the target dose was not achieved (45%), mainly due to reported dizziness and postural blood pressure drop.