Sacubitril/Valsartan use in a real world experience : data from a large single-center population of heart failure patients with reduced ejection fraction

Background: Sacubitril/Valsartan has emerged as a novel therapy in the treatment of heart failure (HF) with reduced ejection fraction (HFrEF), showing a lower cardiovascular mortality and HF hospitalization rates compared to standard therapy. Although the recent idespread use of Sacubitril/Valsartan, real life data are still lacking. Aim of the study and methods: We performed a retrospective analysis of 201 monocentric patients with HFrEF, who started Sacubitril/Valsartan between September 2016 and December 2018 and followed at our HF ambulatory (Centro Cardiologico Monzino, IRCCS, Italy). We collected demographic data, clinical history with ongoing medications, baseline clinical characteristics and blood sample (i.e. Haemoglobin, creatinine, potassium, sodium, NT-proBNP or BNP) and follow up (i.e. period of treatment until last contact with the hospital or by telephone call) about tolerated dose of Sacubitril/Valsartan, interruption of treatment, hospitalization for HF, deaths. Results: Baseline characteristics of our population and of PARADIGM trial are presented in Tab. 1 and Fig.1A. One hundred and five patients also performed a cardiopulmonary exercise test before starting treatment, showing a mean peak VO2 of 14.9 ± 4.7 ml/min/kg (60 ± 17 % of predicted), with VE/VCO2 slope of 34.3±8.2, VO2/work of 9.4±1.5. During follow up (268 ±185 days) 36 patients had hospitalization for HF, while 20 patients interrupted treatment with Sacubitril/Valsartan (7 hypotension, 5 renal insufficiency, 1 angioedema, 7 not known/patient decision) and 9 deceased. Dose administered at baseline and at the end of follow-up is reported in Fig. 1B. Conclusions: Compared to PARADIGM trial, our real-life population has similar characteristics and HF gravity. For clinical reasons during follow up only 31% reached the maximum dose. In future more studies are needed to analyze the prognostic impact of low vs. higher doses.