Tolerability and efficacy of sacubitril/valsartan in clinical practice
Savvy Nandal1, Chee Loong Chow1, Vikki Hannah1
1The Cardiology Department, The Northern Hospital, Melbourne, Victoria, Australia.
Insights
Sacubitril/valsartan improved heart function and quality of life in patients with heart failure with reduced ejection fraction. This therapy is well-tolerated and may redefine optimal medical treatment.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Heart failure (HF) significantly impacts morbidity and mortality.
- Sacubitril/valsartan has shown promise in reducing HF hospitalizations and mortality in specific patient groups.
Purpose of the Study:
- To evaluate the tolerability and effectiveness of sacubitril/valsartan.
- Assessed outcomes in an intention-to-treat patient cohort.
Main Methods:
- Retrospective audit of 65 patients initiated on sacubitril/valsartan.
- Collected clinical outcomes and quality of life data 6-12 months post-initiation.
Main Results:
- Left ventricular ejection fraction improved significantly (29.1% to 33.8%).
- Quality of life scores (EQ5D-VAS) and NYHA class showed significant improvement.
- Symptomatic hypotension occurred in 30% of patients, leading to dose adjustments.
Conclusions:
- Sacubitril/valsartan is a well-tolerated advancement for HF treatment.
- Demonstrated improvements in cardiac function and patient symptoms.
- May alter the definition of optimal medical therapy for device-based interventions.
Background:
Heart failure (HF) is a major cause of morbidity and mortality. Sacubitril/valsartan has demonstrated reductions in HF hospitalisation, and all-cause mortality in patients with heart failure with reduced ejection fraction.
Aims:
To assess the tolerability and efficacy of sacubitril/valsartan in an intention to treat patient cohort.
Methods:
Sixty-five patients who were commenced on sacubitril/valsartan in 2017 at a major metropolitan centre in Victoria were retrospectively audited. Clinical outcomes and quality of life scores were obtained pre and post sacubitril/valsartan commencement through phone and regular clinic follow up, 6-12 months after commencement of sacubitril/valsartan.
Results:
Fourteen percent of patients were able to achieve maximal dose (97/103 mg twice daily) whilst 37% remained on 49/51 mg and 23% on 24/26 mg. The mean systolic blood pressure reduced from 118 ± 18 mmHg to 109 ± 15 mmHg with symptomatic hypotension (30%) being the most common side-effect leading to dose reduction or drug cessation. Left ventricular ejection fraction improved from 29.1 ± 9.7% to 33.8 ± 9.9% (P < 0.05) on drug. There was also a significant improvement in quality of life scores; EQ5D-VAS 40 pre versus 67 post sacubitril/valsartan (P < 0.05), and New York Heart Association class (P < 0.05). Importantly, 10 patients lost an existing indication for device based therapy after treatment with sacubitril/valsartan.
Conclusions:
Sacubitril/valsartan is a much needed therapeutic advancement in the treatment of HF. Our study indicates it is well tolerated with improvements in cardiac function and symptoms. Sacubitril/valsartan could redefine the definition of 'optimal medical therapy' when assessing patients for device based therapies.
Related Concept Videos
01:22Dose-Response Relationship: Potency and Efficacy
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Heart Failure V: Medical Management
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
01:15Bioavailability Study Design: Healthy Subjects Versus Patients
01:06Renal Drug Clearance: Overview
Renal clearance can be calculated using different methods. One approach is to divide the urinary drug excretion rate by the plasma drug concentration. This method directly measures renal clearance, indicating the kidneys' efficiency in...