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In HFREF patients, sacubitril/valsartan, given at relatively low doses, does not lead to increased mortality or

R De Vecchis1,2, C Ariano3,4, G Di Biase5

  • 1Preventive Cardiologyand Rehabilitation Unit, DSB 29 "S. Gennaro dei Poveri Hospital", via S.Gennaro dei Poveri 25, 80136, Napoli, Italy. devecchis.erre@virgilio.it.

Herz
|March 10, 2018
PubMed

Insights

Reduced doses of sacubitril/valsartan are safe for heart failure patients intolerant to maximum doses. This approach did not increase mortality or hospitalizations for heart failure compared to target doses.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Heart failure with reduced ejection fraction (HFREF) management involves gradual sacubitril/valsartan titration.
  • Dose reduction or interruption is recommended for patients experiencing tolerability issues.

Purpose of the Study:

  • To estimate the proportion of patients on minimum or intermediate sacubitril/valsartan doses.
  • To compare all-cause mortality and heart failure hospitalizations between patients on optimal and sub-maximum sacubitril/valsartan doses.

Main Methods:

  • Retrospective analysis of 68 HFREF patients on sacubitril/valsartan, beta-blockers, and mineralocorticoid receptor blockers.
  • Identified 20 patients (29.4%) with contraindications for full-dose sacubitril/valsartan.
  • Assessed outcomes in patients maintained on reduced (minimum/intermediate) versus target doses.

Main Results:

  • After a median 5.25-month follow-up, no significant difference in all-cause mortality risk was observed between reduced and target dose groups (OR=1.666, p=0.6266).
  • Patients on reduced sacubitril/valsartan doses showed a similar risk of heart failure hospitalizations compared to those on target doses (OR=0.789, p=1.00).

Conclusions:

  • In HFREF patients intolerant to maximum sacubitril/valsartan doses, reduced doses did not elevate all-cause mortality.
  • Reduced sacubitril/valsartan dosing did not increase heart failure hospitalizations compared to target doses over a median follow-up of 5.25 months.
Abstract

Keywords:
Drug contraindicationsHeart failureMortalityRetrospective studyVentricular ejection fraction

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