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Effect of sacubitril/valsartan in real-world patients in South London

Session Poster Session 3

Speaker Niels Holm

Event : Heart Failure 2019

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

Authors : N Holm (Zurich,CH), D Bromage (London,GB), J Decourcey (London,GB), TA Mcdonagh (London,GB)

Authors:
N Holm1 , D Bromage2 , J Decourcey2 , TA Mcdonagh2 , 1Triemli Hospital, Klinik für Kardiologie - Zurich - Switzerland , 2Kings College Hospital, Cardiology - London - United Kingdom of Great Britain & Northern Ireland ,

Citation:

Introduction
Our Heart Failure Unit in South London provides specialist care for a socially and economically diverse community. We present our experience with sacubitril/valsartan in this cohort.

Purpose
There is limited real-world data of sacubitril/valsartan, especially in black patients. Therefore we investigated the efficacy of this drug in a diverse patient population, which included a significant proportion of black patients.

Methods
This is a retrospective, observational, single-centre study of patients with symptomatic heart failure (LVEF <35%) on optimal medical therapy, who were transitioned to sacubitril/valsartan. Data were collected manually from our electronic patient records. Statistical analysis was performed with GraphPad Prism 7.04.

Results
A total of 87 patients were analysed (mean age 58 years, 39% female, 44% of black ethnicity, 59% with non-ischaemic cardiomyopathy, 80% on target dose of 200mg BD). Sacubitril/valsartan lead to an improvement of LVEF. This effect was significant only in patients with non-ischaemic cardiomyopathy, in white individuals, and in males.
Sacubitril/valsartan had no impact on heart rate, while reducing blood pressure in white, but not black patients. After 3 months of treatment, there was clinical improvement assessed by NYHA class, independent of ethnicity, and by Minnesota living with heart failure questionnaire, but only in white patients. In addition, NT-proBNP levels dropped significantly after 3 months of treatment.

Conclusion
Sacubitril/valsartan improves LVEF, but there may be individual factors leading to non-response, such as black ethnicity, ischaemic cardiomyopathy, and female gender. Improvement of LVEF to >35% was observed in 18% of patients, most of whom had non-ischaemic cardiomyopathy. This could be clinically relevant considering the current criteria for primary prevention ICD implantation. In our cohort, the positive effect of sacubitril/valsartan is mainly seen in white, but not in black patients. It remains unclear if there is reduced efficacy of the drug in black patients, or whether there are other explanations.

Baseline Follow-up p-value

LVEF (n = 38)

30.3 ± 1.1% 33.3 ± 1.4 % 0.004

NT-proBNP (n = 81)

3657 ± 619 ng/l 3044 ± 782 ng/l 0.0012

Heart rate (n = 38)

67.9 ± 1.9 bpm 63.1 ± 1.9 bpm ns

Systolic BP (n = 87)

120 ± 1.8 mmHg 114 ± 2.0 mmHg 0.0018

NYHA class (n = 87)

2.5 ± 0.1 1.9 ± 0.1 < 0.001
MLWHF Score (n = 64) 43.0 ± 3.4 32 ± 3.0 0.001
Results are presented as mean ± SEM.

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