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

Data de publicação:

Autores da FMUP

  • Emilia Da Conceição Torres Dias Moreira

    Autor

  • Manuel Belchior Campelo

    Autor

  • Sandra Maria Resende Amorim

    Autor

  • Alexandra Isabel Coelho De Sousa

    Autor

  • Brenda Eugénia Carvalho De Moura Cardoso

    Autor

  • Roberto Rodrigues Pinto

    Autor

  • José Carlos De Magalhães Silva Cardoso

    Autor

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

Cardiovascular Diagnosis and Therapy  AME Publishing Company

Tipo:
Article
Páginas:
1217-1217
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 4

Citações Recebidas na Scopus: 6

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Keywords

  • Sacubitril; valsartan; heart failure (HF); neurohormonal modulation; real-life practice; financial barriers

Financiamento

Proyectos asociados

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Investigador Principal: José Carlos de Magalhães Silva Cardoso

Estudo Observacional Académico (IC_Congestiva) . 2019

This Study Tests Empagliflozin in Patients With Chronic Heart Failure With Preserved Ejection Fraction (HFpEF). The Study Looks at How Far Patients Can Walk in 6 Minutes and at Their Heart Failure Symptoms (EMPERIAL) - NCT03448406

Investigador Principal: José Carlos de Magalhães Silva Cardoso

Ensaio Clínico Comercial (EMPERIAL) . Boehringer Ingelheim . 2020

Envolva-se com o seu coração: Promoção da adesão terapêutica com um sistema de telemonitorização para pessoas com insuficiência cardíaca crónica. (AdHeart)

Investigador Principal: José Carlos de Magalhães Silva Cardoso

Estudo de Intervenção Académico (AdHeart) . FCT . 2019

Sacubitril/Valsartan in everyday clinical practice: the experience of a heart failure clinic

Investigador Principal: José Carlos de Magalhães Silva Cardoso

Estudo Clínico Académico (Sacubitril/Valsartan) . 2020

Insuficiência Cardíaca com Fração de Ejeção Intermédia – Estado da Arte

Investigador Principal: Manuel Belchior Campelo

Estudo Clínico Académico . 2020

Avaliação da aorta ascendente em doentes operados a tetralogia de Fallot: implicações no follow-up clínico e imagiológico

Investigador Principal: José Carlos de Magalhães Silva Cardoso

Estudo Clínico Académico . 2020

Hyperkalemia as a limiting factor of Neurohormonal Blockade/Modulation in everyday clinical practice

Investigador Principal: José Carlos de Magalhães Silva Cardoso

Estudo Clínico Académico . 2020

Reversão da remodelagem ventricular na miocardiopatia dilatada idiopática

Investigador Principal: José Carlos de Magalhães Silva Cardoso

Estudo Clínico Académico . 2019

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