Key result
Inpatient sacubitril/valsartan initiation carries ~20% intolerance, though newly diagnosed HF patients tolerate it better.
Why the study?
Initiation of sacubitril/valsartan has primarily been studied in stable, ambulatory patients with HFrEF, with limited data on inpatient initiation tolerance.
What are the risk factors for intolerance to inpatient initiation of sacubitril/valsartan in hospitalized patients?
Observational (n=143)
No
What are the risk factors for intolerance to inpatient initiation of sacubitril/valsartan in hospitalized patients?
Inpatient initiation of sacubitril/valsartan is generally well-tolerated, particularly in patients with newly diagnosed heart failure, though hypotension is a common adverse event.
Risk factors for inpatient sacubitril/valsartan intolerance may guide caution in HFrEF; leaves open prospective validation before practice change.
Background: Sacubitril/valsartan has been shown to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, initiation of sacubitril/valsartan has primarily been studied in stable, ambulatory patients with HFrEF. Objective: The objective of this study was to determine risk factors for intolerance to inpatient sacubitril/valsartan initiation. Methods: This was a retrospective, single-center study from August 1, 2015 through April 30, 2018. Patients were at least 18 years old and were newly initiated on sacubitril/valsartan during their hospitalization. Results: A total of 143 patients met inclusion criteria. Of these patients, 20.3% (n = 29) were intolerant to inpatient initiation of sacubitril/valsartan. The primary reason for intolerance was hypotension (n = 19, 65.5%). Patients with newly diagnosed heart failure were more likely to tolerate the initiation of sacubitril/valsartan (32.5% vs 10.3%; P = 0.03). No differences between groups were identified among other potential predictors for intolerance to sacubitril/valsartan, including systolic blood pressure, acutely decompensated heart failure, or serum creatinine. The most common adverse event was hypotension, which occurred in 26.6% (n = 38) of all patients. Conclusion: The majority of inpatients tolerated sacubitril/valsartan initiation. Larger, prospective, randomized controlled trials would be helpful in further determining ideal candidates for inpatient sacubitril/valsartan initiation.
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Akerman et al. (2019) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=143). Inpatient sacubitril/valsartan initiation was evaluated on Intolerance to inpatient sacubitril/valsartan initiation. Inpatient initiation of sacubitril/valsartan resulted in a 20.3% intolerance rate, though patients with newly diagnosed heart failure were more likely to tolerate it (32.5% vs 10.3%; P=0.03).
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