Background Recommendations approved by the local Pharmacy and Therapeutics Committee (PTC) for the prescription of Sacubitril/Valsartan (SV) are: patients with chronic symptomatic heart failure (HF) (II–III grade following New York Association (NYHA)) with reduced left ejection fraction (LVEF <35%) and elevated N-terminal Pro B-type natriuretic peptide (NT-proBNP >640 pg/ml) seric levels to be treated with standard of care therapy: angiotensin converting enzyme inhibitors (ACE) or angiotensin II receptor blockers (ARB), in combination with beta-blockers (BB) and mineralcorticoid antagonists.
Purpose To evaluate the adherence to the recommendations of the PTC concerning the prescriptions of SV on hospital admission.
Material and methods A descriptive, observational and prospective study including patients treated with SV from March 2018 to July 2018 in a General Teaching Hospital.
Variables considered were: sex, age, patient chronic and fragile (G3), according to the stratification of the regional Health Service, HF NYHA classification, LVEF, NT-proBNP, previous treatment with ACE inhibitors/ARBs, BB and mineralcorticoid antagonists at hospital admission and glomerular filtration rate (GFR).
Results Fifty-one patients were included: 84% (43/51) were men, average 69±11 years and 51% (30/51) were G3.
According to the PTC’s recommendations: 26/51 (51%) patients with NYHA III and 20% (10/51) NYHA II grade. The median of NT-proBNP was of 2,396 pg/ml (247–49, 280), 31/51 (61%) patients had NT-proBNP levels registered in the electronic clinical record (ECR), 3/31 (10%) patients had NT-proBNP <640 pg/ml: the average of LVEF was 31%±8%, 39/51 (76%) patients had LVEF levels registered in ERC, 8/51 (16%) patients had LVEF >35%. Ninety per cent of patients received ACE or ARB and 57% (29/51) received both BB and mineralcorticoid antagonists. Just 27/51 (53%) of patients were well-treated with standard care therapy (ACE/ARBs, BB and mineralcorticoid antagonists). Two per cent (1/51) of patients had GFR <30 ml/min. After the study period, 82% (42/51) of patients continued treatment with SV and patients were followed by primary care physicians.
Conclusion The results show a low adherence of prescriptions with SV according to the PTC’s recommendations. The recording of the variables NT-proBNP and LVEF in the ECR could be improved.
References and/or acknowledgements https://doi.org/10.1093/eurheartj/ehw128
No conflict of interest.
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