Sacubitril/valsartan in everyday clinical practice: an observational study based on the experience of a heart failure clinic

Autores da FMUP
Participantes de fora da FMUP
- Cabral, J
- Vasconcelos, H
- Maia-Araújo, P
- Dias, C
Unidades de investigação
Abstract
Background: Heart failure (HF) is a growing public health problem. Sacubitril/valsartan is now recommended to be used in persistently symptomatic patients with left ventricular ejection fraction (LVEF) <40%, replacing angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs). In the present study, we aimed to characterise the challenges of sacubitril/valsartan use in everyday clinical practice. Methods: We assessed the medical records of patients with HF and reduced ejection fraction eligible for sacubitril/valsartan attending a HF clinic at a Portuguese University Hospital during 2018 (n=152). The number of eligible patients receiving the drug and the reasons for not prescribing sacubitril/valsartan were evaluated. Additionally, we assessed the tolerability of maximal doses of sacubitril/valsartan. New York Heart Association functional class (NYHA class) and LVEF before and after up-titration to maximal tolerated sacubitril/valsartan dose were compared. Median follow-up was 41 months. Results: Of the 152 included patients, 75 (49%) were prescribed the drug. The two main reasons for non-prescription were patient financial barriers (31%) and hypotension (27%). Only 33% of patients on sacubitril/valsartan did reach maximal dose. Hypotension was the main limiting factor for dose optimisation. Duration of sacubitril/valsartan treatment showed a positive association with LVEF improvement during follow-up (6.6% absolute LVEF increase/year). NYHA functional class improved significantly from baseline through the end of follow-up. Conclusions: In every-day clinical practice, although sacubitril/valsartan was associated with a marked improvement in NYHA class and in LVEF, important financial and clinical barriers to the implementation of this therapy were identified.
Dados da publicação
- ISSN/ISSNe:
- 2223-3660, 2223-3652
- Tipo:
- Article
- Páginas:
- 1217-1217
- DOI:
- 10.21037/cdt-21-312
- Link para outro recurso:
- www.scopus.com
Cardiovascular Diagnosis and Therapy AME Publishing Company
Citações Recebidas na Web of Science: 4
Citações Recebidas na Scopus: 6
Documentos
- Não há documentos
Filiações
Keywords
- Sacubitril; valsartan; heart failure (HF); neurohormonal modulation; real-life practice; financial barriers
Campos de estudo
Financiamento
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Citar a publicação
Cabral J,Vasconcelos H,Maia P,Moreira E,Campelo M,Amorim S,Sousa A,Moura B,Pinto R,Dias C,Silva J. Sacubitril/valsartan in everyday clinical practice: an observational study based on the experience of a heart failure clinic. Cardiovasc. Diagn. Theer. 2021. 11. (6):p. 1217-1217. IF:2,552. (3).