Background In Spain, a therapeutic positioning report (TPR) for sacubitril valsartan indicates its use in adult patients for the treatment of symptomatic chronic heart failure and reduced ejection fraction (left ventricular ejection fraction (LVEF) ≤35%), elevated B-type natriuretic peptid (BNP) seric levels and patients previously treated well with standard of care therapy (ACE inhibitors/ARBs, beta-blockers, mineralcorticoid antagonists and diuretics).
Purpose To evaluate the suitability of sacubitril valsartan prescriptions to the recommendations in a health management area.
Material and methods Retrospective descriptive study including patients treated with sacubitril valsartan from September 2016 until July 2017.
Variables considered were: sex, age, treatment with ACE inhibitors/ARBs, beta-blockers, mineralcorticoid antagonists and/or diuretics, dosage regimen, contraindications or intolerance to standard therapy, LVEF previous to sacubitril valsartan, dose escalation, dose reduction, discontinuation and cause of discontinuation.
To evaluate the suitability of the prescriptions we analysed: intolerance/contraindications to standard therapy, therapy before change, dosage regimen, dose tritation and LEVF ≤35%. Audit data were sent to their prescriptors to review.
For data compilation we used the Microstrategy® prescription database and medical records.
Results Fifty-three patients started treatment with sacubitril valsartan in the cited period. Median age was 66.6 years: 83% (n=44) were men.
According to previous standard care received: seven patients (13.2%) had not received ACE inhibitors/ARBs and only six patients (11.3%) received optimal doses of these.
As for beta-blockers, nine patients (16.98%) had not received them and only five patients (9.4%) had received the optimal dose. Regarding mineralcorticoid antagonist, 14 patients had not received them (26.4%) and three patients received the optimal dose. LVEF was >35% in 16 patients.
Overall, none of our patients met all the predetermined conditions in the TPR. No intolerance or contraindication to standard therapy was notified.
A correct dose tritation or appropiate periodic examination was made in only 16 patients (30%).
During the considered period, one patient received a reduced dose for hypotension and 10 patients discontinued treatment: four lack of indication, one economic conditions, one death, two hypotension and one cardiac transplantation.
Conclusion The results show an inadequate use of sacubitril valsartan according to TPR indications in most cases. With this analysis we intend to improve sacubitril valsartan use in our reference area. Audits are an effective method to improve the rational use of medicines.
No conflict of interest
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