Real-World Usage of Sacubitril/Valsartan in Korea: A Multi-Center, Retrospective Study

Figures

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  Figure 1. Titration patterns during the 12 months. Upper panel: all patients enrolled in the study. Lower panel: patient data stratified by sacubitril/valsartan index date. No titration (patients who remained on the same dose of sacubitril/valsartan throughout the follow-up period); up/down titration (patients who experienced initial increase in sacubitril/valsartan dose followed by subsequent down-titration of dose); stable up-titration (patients who experienced initial increase in sacubitril/valsartan dose without subsequent decrease in dose); down/up titration (patients who experienced initial decrease in sacubitril/valsartan dose followed by subsequent up-titration of dose); and stable down-titration (patients who experienced initial decrease in sacubitril/valsartan dose without subsequent increase in dose).

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  Figure 2. Changes in clinical and laboratory parameters from baseline to 12 months. (A) Change in systolic blood pressure and estimated glomerular filtration rate. (B) Changes in echocardiographic parameters. (C) Change in NT-proBNP level. SBP = systolic blood pressure; eGFR = estimated glomerular filtration rate; LVEF = left ventricular ejection fraction; LVEDVI = left ventricular end-diastolic volume index; NT-proBNP = N-terminal B-type pro-natriuretic peptide.

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  Figure 3. Real world use of angiotensin-neprilysin receptor inhibitor in Korea. In the real-world with 600 heart failure and reduced ejection fraction patients prescribed with sacubitril/valsartan, the proportion of patients with target dose increased from 4.8% to 24.8%, whereas the proportion of patients with low dose decreased from 59.2% to 31.7%, at baseline and at follow-up, respectively. During follow-up, the systolic blood pressure decreased only by 2.1 mmHg, and that of estimated glomerular fraction rate by 2.1 ml/min/1.73m2. Many patients experienced cardiac reverse remodelling reflected by a profound decrease in NT-proBNP level, LV size, and an increase in LVEF. SBP = systolic blood pressure; eGFR = estimated glomerular filtration rate; LVEF = left ventricular ejection fraction; LVEDVI = left ventricular end-diastolic volume index; NT-proBNP = N-terminal B-type pro-natriuretic peptide.