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Factors Associated With Sacubitril/Valsartan Continuation and the Methods of Combining Heart Failure Medications in
Erika Iwasaki1, Noriko Kohyama1, Mayumi Inamoto2,3
1Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, Tokyo, Japan.
Insights
Sacubitril/valsartan (SV) continuation is linked to higher albumin, BMI, and SBP. Initiating SV alone, without other heart failure medications, may improve its long-term use in HFrEF patients.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Sacubitril/valsartan (SV) is a key treatment for heart failure (HF).
- Guidelines recommend a four-drug regimen for HF with reduced ejection fraction (HFrEF), including SV.
- Limited data exists on patient characteristics influencing SV continuation and optimal initiation strategies.
Purpose of the Study:
- To identify factors associated with the continuation of Sacubitril/valsartan (SV) therapy for heart failure (HF).
- To examine the impact of different heart failure medication combination strategies on SV continuation.
Main Methods:
- Retrospective cohort study of HF patients initiating SV.
- Multivariate analysis to determine factors for SV continuation over 6 months.
- Analysis of HF medication initiation timing, combination patterns, and SV continuation in HFrEF patients.
Main Results:
- 79.0% of patients continued SV for 6 months.
- Higher albumin (≥ 3.5 g/dL), BMI (≥ 18.5 kg/m²), and SBP (≥ 110 mmHg) were significantly associated with SV continuation.
- In HFrEF patients, non-simultaneous initiation of other HF medications with SV correlated with higher continuation rates (67.3% vs 33.3%).
Conclusions:
- Albumin, BMI, and SBP can help identify patients likely to continue SV therapy.
- Initiating SV as a standalone therapy, without concurrent initiation of other HF medications, may enhance SV continuation in HFrEF patients.
Background:
Sacubitril/valsartan (SV) is recommended for patients with heart failure (HF). In addition, a combination of 4 HF medications, including SV, is recommended in patients with HF with reduced ejection fraction (HFrEF). However, evidence on the characteristics of patients who could continue SV and its initiation methods is limited.
Objective:
To investigate the factors associated with SV continuation and methods of combining HF medications.
Methods:
This retrospective cohort study included HF patients who initiated with SV at our institution. The endpoint was SV continuation for 6 months after its initiation. Multivariate analysis was used to extract factors associated with SV continuation. The relationship between the methods of combining HF medications (renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or sodium-glucose cotransporter 2 inhibitors), including the number of HF medications, their combination patterns, and the timing of their initiation, and SV continuation was examined in patients with HFrEF.
Results:
Of 186 eligible patients, 68.8% had HFrEF, and 79.0% continued SV for 6 months. Significant factors associated with SV continuation were albumin ≥ 3.5 g/dL (odds ratio, 4.81; 95% confidence interval, 2.19-10.59), body mass index (BMI) ≥ 18.5 kg/m2 (4.17; 1.10-15.85), and systolic blood pressure (SBP) ≥ 110 mmHg (2.66; 1.12-6.28). In patients with HFrEF, the proportion of HF medications not initiated simultaneously with SV was significantly higher in the continuation group than in the discontinuation group (67.3% vs 33.3%, P = 0.002). The number of HF medications and their combination patterns were not significantly associated with SV continuation.
Conclusion And Relevance:
Albumin, BMI, and SBP are useful indicators for selecting patients who are likely to continue SV. In addition, initiating only SV without simultaneously initiating other HF medications in patients with HFrEF may lead to SV continuation.
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