Background and importance Sacubitril/valsartan (SV) is a drug for chronic symptomatic heart failure (HF) with reduced left ejection fraction (LVEF). The PARADIGM-HF study demonstrated that SV was superior to standard treatment, reducing the absolute risk of cardiovascular death or hospitalisation for HF by 4.7%.
Aim and objectives The objectives of this study were to evaluate the adherence of clinicians to the recommendations of the Pharmacy and Therapeutics Committee (PTC) for the prescription of SV, as well as to estimate the number of patients who were readmitted due to decompensation of HF and the number who died from any cause.
Material and methods A prospective study that included patients treated with SV was carried out from February to August 2020. Variables considered were: sex, age, LVEF, N-terminal pro B-type natriuretic peptide (NT-proBNP), standard treatment, New York Heart Association (NYHA) classification and mortality and/or hospitalisations due to HF at 6 months.
Recommendations approved by the PTC for the prescription of SV were: LVEF ≤35%, NT-proBNP >400 pg/mL, NYHA class II-III and standard therapy (angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers plus beta-blockers and mineralocorticoid antagonists).
Results A total of 54 patients were included (89% men) with a median age of 72 (32–87) years. 23 patients (43%) started treatment during their hospital admissions, while 31 (57%) received the drug before admission.
Overall adequation to the first prescription of SV was achieved in 5/23 patients (21.7%). Adequation for each individual item was as follows: LVEF ≤35% in 18 patients (74%), NT-proBNP >400 pg/mL in 23 (100%), NYHA II-III in 17 (74%) and just 8 patients were successfully treated with standard therapy.
72% (39/54) of patients continued treatment after being discharged from hospital and 64% (34/53) continued with this drug 6 months later. Four patients were readmitted once, and another four twice, as a consequence of decompensation of the HF during the 6 months of follow-up. Eight patients died during this period.
Conclusion and relevance Clinicians mostly adapt to the utilisation criteria established by the PTC except for the recommended standard treatment, and the percentage of readmissions due to decompensation of HF in our cohort of patients is higher when compared to the clinical trial.
Conflict of interest No conflict of interest
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