In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to HFA Silver & Gold Members, Fellows of the ESC and Young combined Members

Prescription of sacubitril/valsartan in a real-world population

Session Poster Session 2

Speaker Joao AGOSTINHO

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : JR Agostinho (Lisbon,PT), T Rodrigues (Lisbon,PT), R Santos (Lisbon,PT), N Cunha (Lisbon,PT), J Rigueira (Lisbon,PT), A Nunes-Ferreira (Lisbon,PT), I Aguiar-Ricardo (Lisbon,PT), I Goncalves (Lisbon,PT), T Guimaraes (Lisbon,PT), S Longo (Lisbon,PT), F Veiga (Lisbon,PT), M Ribeiro (Lisbon,PT), N Lousada (Lisbon,PT), FJ Pinto (Lisbon,PT), D Brito (Lisbon,PT)

Authors:
JR Agostinho1 , T Rodrigues1 , R Santos1 , N Cunha1 , J Rigueira1 , A Nunes-Ferreira1 , I Aguiar-Ricardo1 , I Goncalves1 , T Guimaraes1 , S Longo1 , F Veiga1 , M Ribeiro1 , N Lousada1 , FJ Pinto1 , D Brito1 , 1Hospital Universita­rio de Santa Maria/CHLN CAML CCULFaculdade de Medicina Universidade de Lisboa - Lisboa - Portugal ,

On behalf: RICA-HFTeam

Citation:

Introduction: Sacubitril/valsartan (S/V) introduction in the heart failure (HF) with a reduce ejection fraction (rEF) therapeutic algorithm was the biggest advance in this syndrome treatment in recent years. Given the small amount of time elapsed since S/V introduction, there are no comparative data between real-life populations and the PARADIGM-HF Trial population.

Objective: To characterize a population followed in the HF Clinic of a Tertiary Hospital medicated with S/V and to compare it with the PARADIGM-HF Trial population.

Methods: Prospective data recording study of pts with HFrEF treated with S/V. Clinical and demographic characteristics, S/V doses, adverse effects and concomitant therapy data were recorded. Comparisons with the PARADIGM-HF S/V treated population were established by Student's T-test and ANOVA.

Results: One hundred and two pts were included. Median follow-up time since S/V first dose was 6 (4-10) months. The present study population presents statistically higher mean age, NTproBNP and serum creatinine levels (Cr) when compared to the PARADIGM-HF population. There was a greater number of pts in NYHA functional class I and II and ischemic etiology was less frequent. There were no significant differences regarding gender, systolic blood pressure or baseline ejection fraction (Table 1).

This real World population had a higher rate of ß-blocker and mineralocorticoid receptor antagonist prescription (Table 1). In this population, 59 pts (57.8%) started on S/V at the dose of 24+26mg and 43 pts (42.2%) at the intermediate dose. The average maximum tolerated dose was significantly lower than that reported in PARADIGM-HF (175±84 vs 375±71 mg/day, <0.001): low dose in 28 pts (27.5%), intermediate dose in 54 pts (52.9%) and high dose in 20 pts (19.6%). The mean dose of ACEi/ARB before S/V initiation was lower than that reported in PARADIGM-HF (dose equivalent to enalapril 14.75±11.75 mg/day vs 18.9±3.4, P =0.01) and 4 pts (3.9%) were medicated with ACEi/ARB previously. The rate of ICD and/or CRT was much higher in the real world population (table 1).

S/V was discontinued in 7 pts (6.9 vs 2.3%, P = NS): in 4 pts due to hypotension (3.9 vs 0.9%, P =0.011), in 1 due to cough (1 vs 0%, P =NS), in 1 due to angioedema (1 vs 0.4%, p =0.003) and in 1 due to HF decompensation (1 vs 0%, P =NS).

The mortality rate in this study population was 3.9% (4 pts).

Conclusions: When comparing the PARADIGM-HF Trial population with a real World population it is evident that the latter is composed of older patients with higher levels of NTproBNP and Cr. In this every-day HFrEF population maximal S/V tolerated doses were lower than those reported in PARADIGM-HF. The rate S/V discontinuation due to adverse events was similar, attesting the safety of the drug.

Get your access to resources

Join now
  • 1ESC Professional Members – access all ESC Congress resources 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are