1. "Real World" Eligibility for Sacubitril/Valsartan in Unselected Heart Failure Patients: Data from the Swedish Heart Failure Registry.
- Author
-
Simpson J, Benson L, Jhund PS, Dahlström U, McMurray JJV, and Lund LH
- Subjects
- Aged, Aged, 80 and over, Aminobutyrates adverse effects, Angiotensin II Type 1 Receptor Blockers adverse effects, Biomarkers blood, Biphenyl Compounds, Clinical Decision-Making, Drug Combinations, Female, Heart Failure blood, Heart Failure diagnosis, Heart Failure physiopathology, Humans, Male, Middle Aged, Natriuretic Peptide, Brain blood, Neprilysin antagonists & inhibitors, Patient Selection, Peptide Fragments blood, Protease Inhibitors adverse effects, Recovery of Function, Registries, Sweden, Tetrazoles adverse effects, Treatment Outcome, Valsartan, Aminobutyrates therapeutic use, Angiotensin II Type 1 Receptor Blockers therapeutic use, Eligibility Determination, Heart Failure drug therapy, Protease Inhibitors therapeutic use, Stroke Volume drug effects, Tetrazoles therapeutic use, Ventricular Function, Left drug effects
- Abstract
Purpose: PARADIGM-HF demonstrated the superiority of sacubitril/valsartan over enalapril in patients with heart failure and reduced ejection fraction (HF-REF). How widely applicable sacubitril/valsartan treatment is in unselected patients with HF-REF is not known. We examined eligibility of patients with HF-REF for treatment with sacubitril/valsartan, according to the criteria used in PARADIGM-HF, in the Swedish Heart Failure Registry (SwedeHF)., Methods: Patients were considered potentially eligible if they were not hospitalized, had symptoms (NYHA class II-IV) and a reduced LVEF (≤ 40%), and were prescribed an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) at a dose equivalent to enalapril ≥ 10 mg daily. In these patients, we evaluated further eligibility according to the main additional PARADIGM-HF inclusion criteria., Results: Of 12,866 outpatients in NYHA functional class II-IV with an LVEF ≤ 40%, 9577 were prescribed at least 10 mg of enalapril (or equivalent) daily. Complete additional data were available for 3099 of these patients (32.4%) and of them 75.5% were potentially eligible for treatment with sacubitril/valsartan. The most common reason for ineligibility was a low natriuretic peptide level (n = 462, 14.9%). Only a small proportion of patients were ineligible due to low eGFR or serum potassium level. Because only 78% of patients were taking ≥ 10 mg enalapril or equivalent daily, only 58.9% of all patients (75.5% of 78%) were eligible for sacubitril/valsartan., Conclusions: Between 34 and 76% of symptomatic patients with HF-REF in a 'real world' population are eligible for treatment with sacubitril/valsartan, depending on background ACEI/ARB dose. The most common reason for ineligibility is a low natriuretic peptide level.
- Published
- 2019
- Full Text
- View/download PDF