Key result
In a primary care setting, 36.5% of patients with chronic heart failure successfully achieved and maintained the target dose of 200 mg BID sacubitril/valsartan for ≥12 weeks.
Why the study?
Data on switching to sacubitril/valsartan were mostly limited to randomized trials, retrospective analyses, and hospital-based care, despite chronic heart failure patients frequently being followed in primary care.
Can patients with HFrEF successfully transition to and maintain target doses of sacubitril/valsartan in a primary care setting?
Observational (n=58)
Yes
Can patients with HFrEF successfully transition to and maintain target doses of sacubitril/valsartan in a primary care setting?
Transitioning HFrEF patients to sacubitril/valsartan is manageable in primary care, with about a third reaching the target dose and a safety profile similar to specialized care.
AIMS: Switch from angiotensin converting enzyme inhibitor treatment to sacubitril/valsartan (sac/val) is associated with benefit in heart failure with reduced ejection fraction (HFrEF). Reports on management of this switch are largely based on randomized controlled trials, retrospective analyses, and hospital-based care, while patients with chronic heart failure (CHF) are frequently followed-up in primary care. The THESEUS study aimed to characterize the transition to sac/val and early maintenance period of HFrEF in primary care. METHOD AND RESULTS: THESEUS was a prospective, observational, non-interventional study, performed at primary care sites throughout Switzerland. Patient characteristics, sac/val transition, and maintenance were reported at study enrolment and approximately 3 and 6 months after sac/val initiation. The primary endpoint was achievement of 200 mg BID sac/val with maintenance for ≥12 weeks. Secondary outcomes included dosing regimens, healthcare utilization in the 6 months prior to sac/val initiation and during the study, patient well-being, safety, and tolerability. Fifty-eight patients with CHF were enrolled from 45 primary care centres. Six patients were excluded, and 19 achieved the primary endpoint (36.5%, Achievers). Non-Achievers underwent fewer titration steps than Achievers (1.9 ± 0.9 vs. 3.1 ± 1.4). In both groups, patient well-being improved and the percentage of New York Heart Association III patients decreased. Healthcare utilization decreased (19% vs. 30.8% in the 6 months pre-enrolment period). The most frequent reasons for target dose non-achievement were asymptomatic and symptomatic hypotension (15.3% and 12.1%, respectively). CONCLUSIONS: Results from THESEUS suggest that transition to sac/val is manageable in primary care, with a safety profile corresponding to reports from specialized heart failure care.
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Dieterle et al. (2020) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=58). Sacubitril/valsartan was evaluated on Achievement of 200 mg BID sac/val with maintenance for ≥12 weeks. In a primary care setting, 36.5% of patients with chronic heart failure successfully achieved and maintained the target dose of 200 mg BID sacubitril/valsartan for ≥12 weeks.
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