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Determinants of maximal dose titration of sacubitril/valsartan in clinical practice

Pieter Martens1,2, Lina Verluyten1, Heleen Van de Broek1

  • 1Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.

Acta Cardiologica
|November 8, 2019
PubMed

Insights

Maximal sacubitril/valsartan dosing was achieved in 32% of heart failure patients. Younger age, higher blood pressure, lower creatinine, and prior RASi use predicted successful uptitration, alongside structured clinic care.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Limited data exists on sacubitril/valsartan maximal dose tolerability in heart failure.
  • Understanding predictors for achieving maximal dosing is crucial for optimizing treatment.

Purpose of the Study:

  • To evaluate the tolerability and predictors of maximal sacubitril/valsartan dose uptitration in heart failure with reduced ejection fraction (HFrEF) patients.
  • To identify clinical correlates associated with achieving maximal sacubitril/valsartan dosage.

Main Methods:

  • Retrospective analysis of 401 HFrEF patients treated with sacubitril/valsartan.
  • Assessment of predictors for maximal uptitration and associated clinical parameter changes.
  • Analysis included patients with at least one follow-up visit.

Main Results:

  • Uptitration to the maximal dose of sacubitril/valsartan was achieved in 32% of patients.
  • Independent predictors for maximal dose tolerance included younger age, higher systolic blood pressure, lower serum creatinine, and higher prior renin-angiotensin-system inhibitor (RASi) dose.
  • More frequent structured heart failure clinic visits also predicted maximal dose achievement.

Conclusions:

  • Maximal sacubitril/valsartan dosing is feasible in a significant proportion of HFrEF patients.
  • Patient characteristics and heart failure care factors influence the ability to reach maximal doses.
  • Maximal dose patients showed reduced loop diuretic needs and increased creatinine without higher hyperkalemia risk.
Abstract

Keywords:
Heart failuredosingguidelinesoutcomereal world evidencesacubitril/valsartan

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