Key result
Switching to sacubitril/valsartan in optimally treated HFrEF patients improved left ventricular ejection fraction from 26% to 33% at 3 months.
Why the study?
Sacubitril/valsartan is effective for HFrEF in clinical trials, but little is known about its use or impact in real-world practice.
Does switching to sacubitril/valsartan improve functional and echocardiographic outcomes in stable patients with HFrEF on maximally tolerated guideline-directed HF therapies?
Cohort (n=80)
Does switching to sacubitril/valsartan improve functional and echocardiographic outcomes in stable patients with HFrEF on maximally tolerated guideline-directed HF therapies?
Real-world switching to sacubitril/valsartan in optimally treated HFrEF patients yields significant improvements in LVEF, NYHA class, and quality of life at 3 months.
Answers are grounded in this paper and cite their sources.
Switching to sacubitril/valsartan was associated with improved LVEF and QoL in stable HFrEF; supports prospective trials before practice change.
BACKGROUND: Sacubitril/valsartan is an effective treatment for heart failure with reduced ejection fraction (HFrEF) based on clinical trial data. However, little is known about its use or impact in real-world practice. The aim of this study was to describe our routine clinical experience of switching otherwise optimally treated patients with HFrEF to sacubitril/valsartan with respect to patient outcomes such as quality of life (QoL) and echocardiographic variables. METHODS AND RESULTS: From June 2017 to May 2019, 80 consecutive stable patients with HFrEF on established and maximally tolerated guideline-directed HF therapies were initiated on sacubitril/valsartan with bimonthly uptitration. Clinical assessment, biochemistry, echocardiography and QoL were compared pretreatment and post-treatment switching. We were able to successfully switch 89% of patients from renin-angiotensin axis inhibitors to sacubitril/valsartan (71 of 80 patients). After 3 months of switch therapy, we observed clinically significant and incremental improvements in blood pressure (systolic blood pressure 123 vs 112 mm Hg, p<0.001; diastolic blood pressure 72 vs 68 mm Hg, p=0.004), New York Heart Association functional classification score (2.3 vs 1.9, p<0.001), Minnesota Living with Heart Failure Questionnaire score (46 vs 38, p=0.016), left ventricular ejection fraction (26% vs 33%, p<0.001) and left ventricular end systolic diameter (5.2 vs 4.9 cm, p=0.013) compared with baseline. There were no significant changes in renal function or serum potassium. CONCLUSION: This study provides real-world clinical practice data demonstrating incremental improvements in functional and echocardiographic outcomes in optimally treated patients with HFrEF switched to sacubitril/valsartan. The data provide evidence beyond that observed in clinical trial settings of the potential benefits of sacubitril/valsartan when used as part of a multidisciplinary heart failure programme.
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Ganesananthan et al. (2020) conducted a cohort in heart failure with reduced ejection fraction (HFrEF) (n=80). Sacubitril/valsartan vs. Pretreatment baseline was evaluated on Left ventricular ejection fraction (p=<0.001). Switching to sacubitril/valsartan in optimally treated HFrEF patients improved left ventricular ejection fraction from 26% to 33% at 3 months.
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